MEDICARE: DR. RICHARD D KOENIG DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	PO2725	FL

General Provider Information

NPI Number	:	1881739258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD D KOENIG DPM

Provider Business Mailing Address
First Line	:	PO BOX 541637
Second Line	:	#B
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32954-1637
Country	:	US
Telephone Number	:	321-452-5133
Fax Number	:	321-452-5747

Provider Business Practice Location Address
First Line	:	280 N SYKES CREEK PKWY
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3491
Country	:	US
Telephone Number	:	321-452-5133
Fax Number	:	321-452-5747

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	08/14/2012

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