Individual
DR. JUSTIN JACOB KOENIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
621 MEMORIAL DR STE 502, SOUTH BEND, IN 46601
(574) 647-5875
(574) 647-5878
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
02005590A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300024549
—
IN
Enumeration date
04/08/2010
Last updated
12/01/2025
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