MEDICARE: DR. PETER P. KOENIG 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	207R00000X	Internal Medicine Physician	A23943	CA
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	A23943	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1316997877	OTHER	CA	NPI

General Provider Information

NPI Number	:	1316997877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER P. KOENIG M.D.

Provider Business Mailing Address
First Line	:	4940 VAN NUYS BLVD.
Second Line	:	SUITE 200
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1741
Country	:	US
Telephone Number	:	818-528-1222
Fax Number	:	818-528-1225

Provider Business Practice Location Address
First Line	:	4940 VAN NUYS BLVD.
Second Line	:	SUITE 200
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1741
Country	:	US
Telephone Number	:	818-528-1222
Fax Number	:	818-528-1225

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	01/12/2011

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Directions to “ DR. PETER P. KOENIG M.D.” Practice Location

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