Provider Demographics
NPI:1487757381
Name:KOENIGER, MARK ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:KOENIGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:150 VANDENBERG ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80914-4184
Mailing Address - Country:US
Mailing Address - Phone:719-554-3311
Mailing Address - Fax:719-554-3851
Practice Address - Street 1:150 VANDENBERG ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80914-4184
Practice Address - Country:US
Practice Address - Phone:719-554-3311
Practice Address - Fax:719-554-3851
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD 053832L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine