Koenig, Justin Jacob
Koenig, Justin Jacob is an individual health care provider with primary practice located at 621 Memorial Dr Ste 502 , South Bend IN 46601. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Koenig, Justin Jacob can be contacted via phone (574) 647-5875.Contact Information
Primary practice address
621 Memorial Dr Ste 502
South Bend IN 46601
Phone: (574) 647-5875
Fax: (574) 647-5878
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 02005590A | Indiana |
Profile Details
| NPI number | 1821314360 |
|---|---|
| LBN Legal business name | Koenig, Justin Jacob |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 8th, 2010 |
| Last updated | Apr 28th, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1821314360 | NPPES |
| Indiana | MEDICAID | 300024549 |
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