Basic Information
| Provider Information | |||||||||
| NPI: | 1972547438 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOENIG | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 161 N FORGE ST | ||||||||
| Address2: | STE. 198 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303761043 | ||||||||
| FaxNumber: | 3303769951 | ||||||||
| Practice Location | |||||||||
| Address1: | 161 N FORGE ST | ||||||||
| Address2: | STE. 198 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303761043 | ||||||||
| FaxNumber: | 3303769951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 11/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 35053810 | OH | N | Other Service Providers | Specialist | 207RX0202X | 35053810 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 0707604 | 01 | OH | MEDICARE ID | OTHER | 1046051 | 01 | OH | UHC | OTHER | 7927182 | 01 | OH | AETNA | OTHER | 000000134681 | 01 | OH | ANTHEM | OTHER | 830000059 | 01 | OH | RAILROAD MEDICARE | OTHER | 0869387 | 05 | OH | MEDICAID | 341587155C | 01 | OH | ACHS | OTHER | KO0707601 | 01 | OH | MEDICARE ID | OTHER | 0707603 | 01 | OH | MEDICARE ID | OTHER |