Healthcare Provider Details

I. General information

NPI: 1770521502
Provider Name (Legal Business Name): MARK KOENIG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 HARDING RD SUITE 330
NASHVILLE TN
37205
US

IV. Provider business mailing address

300 20TH AVE N STE 403
NASHVILLE TN
37203-5180
US

V. Phone/Fax

Practice location:
  • Phone: 615-259-4545
  • Fax: 615-565-6789
Mailing address:
  • Phone: 615-284-7260
  • Fax: 615-284-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number32261
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number32261
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: