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General NPI Number Information
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NPI Number | 1669090403
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Entity Type | Individual
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Provider Name | MARIANNE GAGNON-KONAMNA M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/08/2020
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 1950 WEST POLK STREET
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 312-864-0395
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Fax |
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Provider Business Mailing Address
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Address Line | 850 SAINT-DENIS ST
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City | MONTREAL
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State | QUEBEC
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Zip | H2X0A9
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Country | CA
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Telephone |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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