1477504868 NPI number — DR. STEVEN B KOENIG MD

Table of content: DR. STEVEN B KOENIG MD (NPI 1477504868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477504868 NPI number — DR. STEVEN B KOENIG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOENIG
Provider First Name:
STEVEN
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477504868
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
925 N 87TH ST
Provider Second Line Business Mailing Address:
THE EYE INSTITUTE
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53226-4812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-456-2020
Provider Business Mailing Address Fax Number:
414-456-6300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
925 N 87TH ST
Provider Second Line Business Practice Location Address:
THE EYE INSTITUTE
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53226-4812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-456-2020
Provider Business Practice Location Address Fax Number:
414-456-6300
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  25324 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002000122S . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1477504868 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180018689 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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