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General NPI Number Information
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NPI Number | 1356510895
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Entity Type | Individual
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Provider Name | DIANA LOUISE KOENIG DO
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Gender | Female
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 9104 STATE HWY 19 OZARKS MEDICAL CENTER WINONA
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City | WINONA
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State | MO
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Zip | 65588
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Country | US
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Telephone | 573-325-4237
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Fax | 573-325-4996
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Provider Business Mailing Address
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Address Line | 1100 KENTUCKY AVENUE OZARKS MEDICAL CENTER
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City | WEST PLAINS
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State | MO
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Zip | 65775
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Country | US
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Telephone | 417-256-9111
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2008008627
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License Number State | MO
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