Provider Demographics
NPI:1831465657
Name:KOENIG, CORY (DO)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:
Last Name:KOENIG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 PROVIDENCE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1235
Mailing Address - Country:US
Mailing Address - Phone:704-749-5800
Mailing Address - Fax:
Practice Address - Street 1:131 PROVIDENCE RD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1235
Practice Address - Country:US
Practice Address - Phone:704-749-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019912207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology