Provider Demographics
NPI:1093903361
Name:KONYECSNI, WILLIAM MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MARK
Last Name:KONYECSNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9701 BRODIE LN
Mailing Address - Street 2:#203
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-6282
Mailing Address - Country:US
Mailing Address - Phone:512-291-1711
Mailing Address - Fax:512-291-1488
Practice Address - Street 1:9701 BRODIE LN
Practice Address - Street 2:#203
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-6282
Practice Address - Country:US
Practice Address - Phone:512-291-1711
Practice Address - Fax:512-291-1488
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK20542084P0800X
AZ320352084P0800X
SC223972084P0800X
GA0525252084P0800X
MO20060055172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ807539OtherAHCCCS
GAG47265Medicare UPIN
TXG47265Medicare UPIN
AZG47265Medicare UPIN
SCG47265Medicare UPIN