MEDICARE: DR. MARK KOENEN 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	MD00041348	WA
2	2084F0202X	Forensic Psychiatry Physician	A106795	CA
3	2084P0800X	Psychiatry Physician	A106795	CA
4	2084F0202X	Forensic Psychiatry Physician	MD00041348	WA

General Provider Information

NPI Number	:	1649414301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK KOENEN MD

Provider Business Mailing Address
First Line	:	601 UNION ST
Second Line	:	SUITE 1704
City	:	SEATTLE
State	:	WA
Zip	:	98101-2341
Country	:	US
Telephone Number	:	206-623-1949
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 UNION ST
Second Line	:	SUITE 1704
City	:	SEATTLE
State	:	WA
Zip	:	98101-2341
Country	:	US
Telephone Number	:	206-623-1949
Fax Number	:

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

Provider Enumeration Date	:	04/26/2009
Last Update Date	:	04/14/2010

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Directions to “ DR. MARK KOENEN MD” Practice Location

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