Healthcare Provider Details

I. General information

NPI: 1821158593
Provider Name (Legal Business Name): CURRY LEE KOENING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF UTAH RHEUMATOLOGY, 4B200 SOM, 50 N MEDICAL DR.
SALT LAKE CITY UT
84105
US

IV. Provider business mailing address

13660 FAIRHILL RD APT 104
SHAKER HEIGHTS OH
44120-1291
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-4333
  • Fax: 801-581-6069
Mailing address:
  • Phone: 801-573-4642
  • Fax: 216-445-7569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number4985225-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: