MEDICARE: DR. WILLIAM MARK KONYECSNI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	K2054	TX
2	2084P0800X	Psychiatry Physician	32035	AZ
3	2084P0800X	Psychiatry Physician	22397	SC
4	2084P0800X	Psychiatry Physician	052525	GA
5	2084P0800X	Psychiatry Physician	2006005517	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	807539	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1093903361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM MARK KONYECSNI MD

Provider Business Mailing Address
First Line	:	9701 BRODIE LN
Second Line	:	#203
City	:	AUSTIN
State	:	TX
Zip	:	78748-6282
Country	:	US
Telephone Number	:	512-291-1711
Fax Number	:	512-291-1488

Provider Business Practice Location Address
First Line	:	9701 BRODIE LN
Second Line	:	#203
City	:	AUSTIN
State	:	TX
Zip	:	78748-6282
Country	:	US
Telephone Number	:	512-291-1711
Fax Number	:	512-291-1488

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2007
Last Update Date	:	10/11/2007

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Directions to “ DR. WILLIAM MARK KONYECSNI MD” Practice Location

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