Provider Demographics
NPI:1790974343
Name:ALLAN CARL KOENIG M.D.
Entity Type:Organization
Organization Name:ALLAN CARL KOENIG M.D.
Other - Org Name:PLATTE VALLEY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESDIENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOENIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-452-4343
Mailing Address - Street 1:3959 E 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-1657
Mailing Address - Country:US
Mailing Address - Phone:303-452-4343
Mailing Address - Fax:303-452-3055
Practice Address - Street 1:3959 E 120TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-1657
Practice Address - Country:US
Practice Address - Phone:303-452-4343
Practice Address - Fax:303-452-3055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26131208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCE9008Medicare PIN