Basic Information
| Provider Information | |||||||||
| NPI: | 1164421897 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KONSENS | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3451 TECHNOLOGICAL AVE STE 15 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328178353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073808705 | ||||||||
| FaxNumber: | 4076432804 | ||||||||
| Practice Location | |||||||||
| Address1: | 3451 TECHNOLOGICAL AVE STE 15 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328178353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073808705 | ||||||||
| FaxNumber: | 4076432804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2005 | ||||||||
| LastUpdateDate: | 11/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0114X | ME0056262 | FL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | 207X00000X | ME0056262 | FL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | ME0056262 | FL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207X00000X | ME56262 | FL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 042914700 | 05 | FL | MEDICAID | 08402 | 01 | FL | BC/BS | OTHER |