MEDICARE: TERESA KOENIG MD

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	35-053840	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0773463	OTHER	OH	MEDICARE ID
2	110146643	OTHER	OH	RAILROAD MEDICARE
4	0773461	OTHER	OH	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	04-03134	OTHER	OH	UNITED HEALTHCARE
5	088	OTHER	OH	SUMMA
6	729118	OTHER	OH	BUCKEYE COMMUNITY HEALTH
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	000000132169	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1386619625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA KOENIG MD

Provider Business Mailing Address
First Line	:	55 ARCH ST
Second Line	:	STE. 1B
City	:	AKRON
State	:	OH
Zip	:	44304-1423
Country	:	US
Telephone Number	:	330-375-3315
Fax Number	:	330-375-3760

Provider Business Practice Location Address
First Line	:	55 ARCH ST
Second Line	:	STE. 1B
City	:	AKRON
State	:	OH
Zip	:	44304-1423
Country	:	US
Telephone Number	:	330-375-3315
Fax Number	:	330-375-3760

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	11/28/2011

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Directions to “ TERESA KOENIG MD” Practice Location

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