Provider Demographics
NPI:1043248966
Name:KOENIG, ALLAN CARL (MD)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:CARL
Last Name:KOENIG
Suffix:
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 1:3959 E 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-1657
Mailing Address - Country:US
Mailing Address - Phone:303-452-4343
Mailing Address - Fax:303-452-3055
Practice Address - Street 1:3959 E 120TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-1657
Practice Address - Country:US
Practice Address - Phone:303-452-4343
Practice Address - Fax:303-452-3055
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26131208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD43460Medicare UPIN
COCE9058Medicare PIN