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General NPI Number Information
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NPI Number | 1184184343
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Entity Type | Individual
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Provider Name | MARCUS KONNER DO
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Gender | Male
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Dates
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Enumeration Date | 03/23/2019
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Last Update Date | 02/22/2025
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Provider Practice Location Address
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Address Line | 500 N HIATUS RD STE 200
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-5213
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Country | US
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Telephone | 954-437-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 10TH AVE # 3A-08
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City | NEW YORK
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State | NY
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Zip | 10019-1147
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Country | US
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Telephone | 212-259-6777
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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 | 2085D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Radiology) Physician
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License Number | OS21580
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Radiology) Physician
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License Number | 311830-01
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License Number State | NY
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