MEDICARE: DR. JANE E KONAKIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	6270	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11040876	OTHER		CAQH

General Provider Information

NPI Number	:	1215935762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANE E KONAKIS MD

Provider Business Mailing Address
First Line	:	850 HARVARD WAY
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-2055
Country	:	US
Telephone Number	:	775-982-5262
Fax Number	:	775-982-5496

Provider Business Practice Location Address
First Line	:	6570 S MCCARRAN BLVD
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89509-6112
Country	:	US
Telephone Number	:	775-982-8256
Fax Number	:	775-982-8251

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	01/03/2018

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