Provider Demographics
NPI:1437214731
Name:KOENIGSMARK, JOSEPH (DO,MBA)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:KOENIGSMARK
Suffix:
Gender:M
Credentials:DO,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 COBBLERS CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9457
Mailing Address - Country:US
Mailing Address - Phone:502-640-4403
Mailing Address - Fax:812-725-8168
Practice Address - Street 1:407 ZINNIA WAY
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-9663
Practice Address - Country:US
Practice Address - Phone:812-288-8410
Practice Address - Fax:812-288-8409
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001067A207QA0401X, 2084A0401X, 207Q00000X, 202C00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical ExaminerGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY11452445OtherCAQH
KY64021611Medicaid
KY64021611Medicaid
KYC68718Medicare UPIN