MEDICARE: DR. JOHN CURTIS EDWARD KOENIG JR. 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	208000000X	Pediatrics Physician	19605	KY
2	2080P0203X	Pediatric Critical Care Medicine Physician	19605	KY

General Provider Information

NPI Number	:	1760757942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN CURTIS EDWARD KOENIG JR. M.D.

Provider Business Mailing Address
First Line	:	3570 VIGO RD
Second Line	:
City	:	BAGDAD
State	:	KY
Zip	:	40003-8022
Country	:	US
Telephone Number	:	502-747-8666
Fax Number	:	502-747-8666

Provider Business Practice Location Address
First Line	:	3570 VIGO RD
Second Line	:
City	:	BAGDAD
State	:	KY
Zip	:	40003-8022
Country	:	US
Telephone Number	:	502-747-8666
Fax Number	:	502-747-8666

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

Provider Enumeration Date	:	03/20/2012
Last Update Date	:	03/20/2012

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