Provider Demographics
NPI:1164421897
Name:KONSENS, RICHARD M (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:KONSENS
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 1:3451 TECHNOLOGICAL AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-8353
Mailing Address - Country:US
Mailing Address - Phone:407-380-8705
Mailing Address - Fax:407-643-2804
Practice Address - Street 1:3451 TECHNOLOGICAL AVE STE 15
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-8353
Practice Address - Country:US
Practice Address - Phone:407-380-8705
Practice Address - Fax:407-643-2804
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056262207XS0114X, 207X00000X, 207XX0005X
FLME56262207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042914700Medicaid
FL08402OtherBC/BS
FL08402ZMedicare PIN
FL042914700Medicaid
FLE22476Medicare UPIN