Provider Demographics
NPI:1023445269
Name:KOENIG, RUSSELL (MS)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:
Last Name:KOENIG
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 W. SCHILLER STREET #1601
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610
Mailing Address - Country:US
Mailing Address - Phone:312-878-8800
Mailing Address - Fax:312-448-9978
Practice Address - Street 1:88 W SCHILLER ST APT 1601
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2041
Practice Address - Country:US
Practice Address - Phone:312-878-8800
Practice Address - Fax:312-448-9978
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist