Provider Demographics
NPI:1770521502
Name:KOENIG, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
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 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5180
Mailing Address - Country:US
Mailing Address - Phone:615-284-7260
Mailing Address - Fax:615-284-7501
Practice Address - Street 1:4230 HARDING RD
Practice Address - Street 2:SUITE 330
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205
Practice Address - Country:US
Practice Address - Phone:615-259-4545
Practice Address - Fax:615-565-6789
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32261207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP01376525OtherRR MEDICARE
TN6012068OtherBLUE CROSS-BLUE SHIELD
TN3330967Medicaid
TN103I069946Medicare PIN
TNP01376525OtherRR MEDICARE
TN3330967Medicare PIN
TNG05367Medicare UPIN