Individual
MR. MICHAEL W KOENIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
442 W HIGH ST STE 3, BRYAN, OH 43506-1681
(419) 636-4517
(419) 636-6438
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
103933
NC
363A00000X
Physician Assistant
Primary
50.003014RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D1248
MEDCOST
NC
Enumeration date
04/26/2006
Last updated
12/12/2022
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