Provider Demographics
NPI:1831191238
Name:KOENIG, WILLIAM CARL JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CARL
Last Name:KOENIG
Suffix:JR
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 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:2600 GRAND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-5375
Practice Address - Country:US
Practice Address - Phone:515-283-1570
Practice Address - Fax:515-283-1681
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21133208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA421169749OtherRR MEDICARE
IA1811942659OtherWELLMARK BCBS
IA1811942659Medicaid
A03873Medicare UPIN
IA1811942659Medicaid