Healthcare Provider Details

I. General information

NPI: 1659483865
Provider Name (Legal Business Name): KARL MARC KOENIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N IH 35 PAUL BASS CLINIC
AUSTIN TX
78701-1926
US

IV. Provider business mailing address

1400 BARBARA JORDAN BLVD STE 1.114
AUSTIN TX
78723-3092
US

V. Phone/Fax

Practice location:
  • Phone: 512-495-5675
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number12999
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberQ6953
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: