Provider Demographics
NPI:1952468415
Name:KOENIG, THOMAS MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MARTIN
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 1:11808 KINGSTON PIKE
Mailing Address - Street 2:SUITE 190
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-3838
Mailing Address - Country:US
Mailing Address - Phone:865-966-7755
Mailing Address - Fax:865-966-7711
Practice Address - Street 1:11808 KINGSTON PIKE
Practice Address - Street 2:SUITE 190
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-3838
Practice Address - Country:US
Practice Address - Phone:865-966-7755
Practice Address - Fax:865-966-7711
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000023543207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN200016210OtherRAILROAD MEDICARE
TN168472OtherBLUE CROSS OF TENNESSEE
TN4857601OtherCIGNA HEALTHCARE
TNTN0101OtherJOHN DEERE
TN0525270001OtherMEDICARE DMERC
TN0940377OtherUNITED HEALTHCARE
TN168472OtherBLUE CROSS OF TENNESSEE
TN0525270001Medicare NSC
TN3067552Medicare PIN
TN621664580OtherFEDERAL TAX ID NUMBER