Active NPI
Earl R Koenig, MD
- Urology Physician
- Utica, MI
National Provider Identifier
1083679070
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 4301030802
- Practice address
- 11051 Hall Rd
Suite 200
Utica, MI 48317-5735 - Phone
- (586) 254-5759
- Fax
- (586) 254-5793
- NPI assigned
- Apr 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | 4301030802 | MI | Primary |
Addresses
Primary practice location
11051 Hall Rd
Suite 200
Utica, MI 48317-5735
Mailing address
20952 E 12 Mile Rd
Suite 200
St Clair Shores, MI 48081-3200
Phone (586) 771-4820
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B45210 | Other | MI | HAP |
| 4391724 | Other | MI | AETNA |
| 5259095001 | Other | MI | CIGNA |
| 102426 | Other | MI | PRIORITY HEALTH |
| 340019484 | Other | MI | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301030802 | MI | MD | Urology Physician |
Interoperability endpoints
- ekoenig58183@direct.hfhs.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217203200000",
"number": "1083679070",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20952 E 12 MILE RD",
"address_2": "SUITE 200",
"city": "ST CLAIR SHORES",
"state": "MI",
"postal_code": "480813200",
"telephone_number": "586-771-4820",
"fax_number": "586-771-6620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11051 HALL RD",
"address_2": "SUITE 200",
"city": "UTICA",
"state": "MI",
"postal_code": "483175735",
"telephone_number": "586-254-5759",
"fax_number": "586-254-5793"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOENIG",
"first_name": "EARL",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-20",
"last_updated": "2008-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "MI",
"license": "4301030802",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HAP",
"identifier": "B45210",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4391724",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "5259095001",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIORITY HEALTH",
"identifier": "102426",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "340019484",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Utica, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.