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General NPI Number Information
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NPI Number | 1033451117
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Entity Type | Individual
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Provider Name | KELLY NICOLE KOENIG MD
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Gender | Female
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 04/28/2017
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Provider Practice Location Address
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Address Line | 200 W PEARL ST
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City | FINDLAY
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State | OH
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Zip | 45840
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Country | US
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Telephone | 419-424-0380
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Fax | 419-424-1888
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Provider Business Mailing Address
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Address Line | 200 W PEARL ST
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City | FINDLAY
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State | OH
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Zip | 45840
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Country | US
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Telephone | 419-424-0380
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Fax | 419-427-1888
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 129326
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License Number State | OH
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Taxonomy #2
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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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