MEDICARE: DR. KARL MARC KOENIG 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	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	12999	NH
2	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	Q6953	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659483865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARL MARC KOENIG MD

Provider Business Mailing Address
First Line	:	1400 BARBARA JORDAN BLVD
Second Line	:	STE 1.114
City	:	AUSTIN
State	:	TX
Zip	:	78723-3092
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 N IH 35
Second Line	:	PAUL BASS CLINIC
City	:	AUSTIN
State	:	TX
Zip	:	78701-1926
Country	:	US
Telephone Number	:	512-495-5675
Fax Number	:

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	05/02/2017

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