MEDICARE: STUART MARK KOENIG D.P.M.

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	213E00000X	Podiatrist	0763	TX

General Provider Information

NPI Number	:	1245571629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STUART MARK KOENIG D.P.M.

Provider Business Mailing Address
First Line	:	5873 NW 125TH TER
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-3488
Country	:	US
Telephone Number	:	954-294-4039
Fax Number	:	561-300-8849

Provider Business Practice Location Address
First Line	:	5873 NW 125TH TER
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-3488
Country	:	US
Telephone Number	:	954-294-4039
Fax Number	:	561-300-8849

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

Provider Enumeration Date	:	03/08/2013
Last Update Date	:	03/08/2013

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