Provider Demographics
NPI:1275828683
Name:KOENIG, JOSHUA BEN (DO)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:BEN
Last Name:KOENIG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27450 SCHOENHERR RD
Mailing Address - Street 2:STE. 400
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6683
Mailing Address - Country:US
Mailing Address - Phone:586-582-7550
Mailing Address - Fax:586-582-7515
Practice Address - Street 1:10047 CROSSROAD CT SE
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-7316
Practice Address - Country:US
Practice Address - Phone:616-685-8850
Practice Address - Fax:586-582-7515
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101019456207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine