Provider Demographics
NPI:1972547438
Name:KOENIG, JOSEPH MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
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 1:161 N FORGE ST
Mailing Address - Street 2:STE. 198
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1468
Mailing Address - Country:US
Mailing Address - Phone:330-376-1043
Mailing Address - Fax:330-376-9951
Practice Address - Street 1:161 N FORGE ST
Practice Address - Street 2:STE. 198
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1468
Practice Address - Country:US
Practice Address - Phone:330-376-1043
Practice Address - Fax:330-376-9951
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053810174400000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0707604OtherMEDICARE ID
OH1046051OtherUHC
OH7927182OtherAETNA
OH000000134681OtherANTHEM
OH830000059OtherRAILROAD MEDICARE
OH0869387Medicaid
OH341587155COtherACHS
OHKO0707601OtherMEDICARE ID
OH0707603OtherMEDICARE ID
OHKO0707601OtherMEDICARE ID