Provider Demographics
NPI:1659483865
Name:KOENIG, KARL MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:MARC
Last Name:KOENIG
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 1:1400 BARBARA JORDAN BLVD
Mailing Address - Street 2:STE 1.114
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3092
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 N IH 35
Practice Address - Street 2:PAUL BASS CLINIC
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1926
Practice Address - Country:US
Practice Address - Phone:512-495-5675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12999207XS0114X
TXQ6953207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30206851Medicaid
VT1013235Medicaid
I68541Medicare UPIN
VT1013235Medicaid
NHVN415603Medicare PIN