Healthcare Provider Details

I. General information

NPI: 1467439166
Provider Name (Legal Business Name): ANDREW A. KONEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 N CENTRAL EXPY SUITE 585
DALLAS TX
75231-0806
US

IV. Provider business mailing address

PO BOX 650426
DALLAS TX
75265-0426
US

V. Phone/Fax

Practice location:
  • Phone: 214-252-9432
  • Fax: 214-252-9464
Mailing address:
  • Phone: 972-715-5007
  • Fax: 972-715-5682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberK0506
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: