Individual
MICHAEL R KOENIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
856 BANKS LOWMAN RD, GARDEN VALLEY, ID 83622-8102
(208) 462-3533
(208) 462-3736
Mailing address
PO BOX 270, GARDEN VALLEY, ID 83622-0270
(208) 462-3533
(208) 462-3736
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M8699
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010140515
BS
ID
05
—
806406200
—
ID
01
—
85795
BC
ID
Enumeration date
06/21/2005
Last updated
04/05/2011
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