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General NPI Number Information
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NPI Number | 1164460358
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Entity Type | Individual
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Provider Name | MARC G. KOENIG SR. MD
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Gender | Male
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 19020 33RD AVE W SUITE 210
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City | LYNNWOOD
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State | WA
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Zip | 98036-4746
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Country | US
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Telephone | 425-563-1500
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Fax | 425-563-1374
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Provider Business Mailing Address
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Address Line | 19020 33RD AVE W SUITE 210
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City | LYNNWOOD
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State | WA
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Zip | 98036-4746
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Country | US
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Telephone | 425-563-1500
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Fax | 425-563-1374
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | EMC0001580
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD60320843
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License Number State | WA
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