Provider Demographics
NPI:1124001607
Name:KOENIG, PATRICK N (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:N
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:N15W28300 GOLF RD
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-4800
Mailing Address - Country:US
Mailing Address - Phone:262-303-5000
Mailing Address - Fax:262-303-5006
Practice Address - Street 1:N15W28300 GOLF RD
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-4800
Practice Address - Country:US
Practice Address - Phone:262-544-5311
Practice Address - Fax:262-303-5006
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37447-020207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1124001607Medicaid
050073336OtherRAIL ROAD MEDICARE
WIG77828Medicare UPIN
WI0019-68625Medicare ID - Type UnspecifiedPROVIDER NUMBER
WI1124001607Medicaid
WI32451800Medicaid