Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 02001067A | IN |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 02001067A | IN |
NPI | 1437214731 |
---|---|
Provider Name | Dr. Joseph Koenigsmark |
First Address | New Albany, IN 47150-9457 |
Second Address | Shepherdsville, KY 40165-9663 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 23/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11452445 | CAQH (01) | KY |
64021611 | (05) | KY |
C68718 | (02) | KY |