Healthcare Provider Details

I. General information

NPI: 1841423035
Provider Name (Legal Business Name): ABSOLUCHAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 N SYKES CREEK PKWY STE B
MERRITT ISLAND FL
32953-3491
US

IV. Provider business mailing address

PO BOX 541637
MERRITT ISLAND FL
32954-1637
US

V. Phone/Fax

Practice location:
  • Phone: 321-452-5133
  • Fax: 321-452-5747
Mailing address:
  • Phone: 321-452-5133
  • Fax: 321-452-5747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO2725
License Number StateFL

VIII. Authorized Official

Name: DR. RICHARD D KOENIG
Title or Position: OWNER
Credential: DPM
Phone: 321-452-5133