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General NPI Number Information
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NPI Number | 1134338924
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Entity Type | Individual
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Provider Name | JOSEPH C KONEN MD
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Gender | Male
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 08/31/2011
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Provider Practice Location Address
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Address Line | 15014 BALLANTYNE COUNTRY CLUB DR
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City | CHARLOTTE
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State | NC
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Zip | 28277-2719
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Country | US
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Telephone | 704-541-5987
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Fax |
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Provider Business Mailing Address
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Address Line | 130 SPINNAKER CT
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City | DAVIDSON
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State | NC
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Zip | 28036-7102
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Country | US
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Telephone | 704-655-2558
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 32004
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License Number State | NC
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