Healthcare Provider Details

I. General information

NPI: 1982678165
Provider Name (Legal Business Name): ELIZABETH KONEFAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N NAPPANEE SUITE 11B
ELKHART IN
46514
US

IV. Provider business mailing address

PO BOX 100
SCHERERVILLE IN
46375
US

V. Phone/Fax

Practice location:
  • Phone: 574-522-9922
  • Fax:
Mailing address:
  • Phone: 219-934-5300
  • Fax: 219-934-5389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01049322A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: