Provider Demographics
NPI:1356386494
Name:KOEDERITZ, NATALIE MARIE (MD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:MARIE
Last Name:KOEDERITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:MARIE
Other - Last Name:ZUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:346 MAINE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1393
Mailing Address - Country:US
Mailing Address - Phone:785-856-7732
Mailing Address - Fax:785-260-6275
Practice Address - Street 1:346 MAINE ST STE 400
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1393
Practice Address - Country:US
Practice Address - Phone:785-856-7732
Practice Address - Fax:785-260-6275
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-32373207WX0110X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200622220AMedicaid
159237Medicare UPIN