MEDICARE: DR. RICHARD M. KONSENS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	ME0056262	FL
2	207X00000X	Orthopaedic Surgery Physician	ME0056262	FL
3	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	ME0056262	FL
4	207X00000X	Orthopaedic Surgery Physician	ME56262	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	08402	OTHER	FL	BC/BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164421897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD M. KONSENS M.D.

Provider Business Mailing Address
First Line	:	3451 TECHNOLOGICAL AVE STE 15
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-8353
Country	:	US
Telephone Number	:	407-380-8705
Fax Number	:	407-643-2804

Provider Business Practice Location Address
First Line	:	3451 TECHNOLOGICAL AVE STE 15
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-8353
Country	:	US
Telephone Number	:	407-380-8705
Fax Number	:	407-643-2804

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	11/23/2020

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Directions to “ DR. RICHARD M. KONSENS M.D.” Practice Location

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