MEDICARE: KOENIG HEALTHCARE EDMOND PLLC

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	208100000X	Physical Medicine & Rehabilitation Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	385049	OTHER	OK	MEDICARE PTAN

General Provider Information

NPI Number	:	1538571690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOENIG HEALTHCARE EDMOND PLLC

Provider Business Mailing Address
First Line	:	800 W 18TH ST STE 100
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-3759
Country	:	US
Telephone Number	:	405-726-2727
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 W 18TH ST STE 100
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-3759
Country	:	US
Telephone Number	:	405-726-2727
Fax Number	:	405-216-5724

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRANT THOMAS KOENIG
Credential	:
Telephone Number	:	405-726-2727

Provider Enumeration Date	:	05/23/2014
Last Update Date	:	02/20/2023

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