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General NPI Number Information
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NPI Number | 1841423035
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Entity Type | Organization
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Legal Business Name | ABSOLUCHAS LLC
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Dates
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Enumeration Date | 09/03/2009
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 280 N SYKES CREEK PKWY STE B
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-3491
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Country | US
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Telephone | 321-452-5133
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Fax | 321-452-5747
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Provider Business Mailing Address
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Address Line | PO BOX 541637
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City | MERRITT ISLAND
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State | FL
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Zip | 32954-1637
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Country | US
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Telephone | 321-452-5133
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Fax | 321-452-5747
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD D KOENIG
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Credential | DPM
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Telephone | 321-452-5133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO2725
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License Number State | FL
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