Provider Demographics
NPI:1508141011
Name:KONING, JULIE M (RD)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:M
Last Name:KONING
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1547
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48068-1547
Mailing Address - Country:US
Mailing Address - Phone:248-795-5494
Mailing Address - Fax:
Practice Address - Street 1:30400 TELEGRAPH RD
Practice Address - Street 2:SUITE 350
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4537
Practice Address - Country:US
Practice Address - Phone:248-353-9466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered