Provider Demographics
NPI:1013002187
Name:KOENIG, DUANE G (MD)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:G
Last Name:KOENIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-2001
Mailing Address - Country:US
Mailing Address - Phone:402-228-4295
Mailing Address - Fax:402-228-3702
Practice Address - Street 1:1123 N 10TH ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-2001
Practice Address - Country:US
Practice Address - Phone:402-228-4295
Practice Address - Fax:402-228-3702
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEB67412Medicare UPIN
NE092848Medicare ID - Type Unspecified