Provider Demographics
NPI:1215007091
Name:KONIKOW, JOEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:C
Last Name:KONIKOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1643
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-1643
Mailing Address - Country:US
Mailing Address - Phone:206-789-5418
Mailing Address - Fax:206-784-9744
Practice Address - Street 1:600 BROADWAY
Practice Address - Street 2:SUITE 530
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5229
Practice Address - Country:US
Practice Address - Phone:206-789-5418
Practice Address - Fax:206-784-9744
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000142042081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2015306Medicaid
A04922Medicare UPIN