Provider Demographics
NPI:1861874315
Name:KOENIGSKNECHT, ANDREW (PA-C)
Entity type:Individual
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First Name:ANDREW
Middle Name:
Last Name:KOENIGSKNECHT
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6790
Mailing Address - Fax:616-486-6702
Practice Address - Street 1:100 MICHIGAN ST NE
Practice Address - Street 2:A721
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:616-486-6790
Practice Address - Fax:616-486-6702
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2021-02-25
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant