MEDICARE: MELINDA KOENIG

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	171100000X	Acupuncturist		WI

General Provider Information

NPI Number	:	1437610219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA KOENIG

Provider Business Mailing Address
First Line	:	500 W SILVER SPRING DR STE K205
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53217-5057
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 W SILVER SPRING DR STE K205
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53217-5057
Country	:	US
Telephone Number	:	414-332-8888
Fax Number	:

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

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	03/26/2019

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Directions to “ MELINDA KOENIG ” Practice Location

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