Provider Demographics
NPI:1285893990
Name:KONING, MICHAEL ALLAN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALLAN
Last Name:KONING
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:PO BOX 748
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:MT
Mailing Address - Zip Code:59875-0748
Mailing Address - Country:US
Mailing Address - Phone:406-642-3958
Mailing Address - Fax:
Practice Address - Street 1:2206 MIDDLE BEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:MT
Practice Address - Zip Code:59875-0748
Practice Address - Country:US
Practice Address - Phone:406-642-3958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33984207L00000X, 207LP2900X
MT11042207L00000X, 207LP2900X
ND6334207L00000X, 207LP2900X
NE20466207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine