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Individual
MRS. DIANA LOUISE KOENIG
Active
Individual
MRS. DIANA LOUISE KOENIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2008008627
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356510895
—
MO
01
—
26D0679044
CLIA (LICKING)
MO
01
—
26D0889777
CLIA (MOB)
MO
01
—
26D1050027
CLIA
MO
01
—
597780303
RH MEDICAID
MO
Enumeration date
02/28/2008
Last updated
02/28/2017
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