Provider Demographics
NPI:1578676235
Name:KOENIG, JOEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:S
Last Name:KOENIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3009 N. BALLAS ROAD
Mailing Address - Street 2:SUITE 141
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131
Mailing Address - Country:US
Mailing Address - Phone:314-994-0209
Mailing Address - Fax:314-994-9130
Practice Address - Street 1:3009 N. BALLAS ROAD
Practice Address - Street 2:SUITE 141
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131
Practice Address - Country:US
Practice Address - Phone:314-994-0209
Practice Address - Fax:314-994-9130
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2021-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOMOR7D83208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G18523Medicare UPIN