Michael G Koenig, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036136533 Issued in IL

Practice address

621 S New Ballas Rd Ste 2003B
Saint Louis, MO 63141-8265

Phone

(314) 251-5811

Fax

(314) 251-5812

NPI assigned

Oct 1, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carestl Health

  • Federally Qualified Health Center (FQHC)
  • Saint Louis, MO
  • NPI 1376685529
  Medicare reassignment NPD
• Mercy Clinic East Communities

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1851335228

  Pediatrics

  Medicare reassignment NPD
• SSM Health Care St Louis

  • Emergency Medicine Physician
  • Fenton, MO
  • NPI 1275586174
  Medicare reassignment NPD
• Carestl Health

  • Federally Qualified Health Center (FQHC)
  • Overland, MO
  • NPI 1275363137
  NPD
• Carestl Health

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1972596088
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1720171093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776084",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776084",
            "telephone_number": "314-251-5811",
            "fax_number": "314-251-5812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 2003B",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418265",
            "telephone_number": "314-251-5811",
            "fax_number": "314-251-5812"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 Terminal Dr Ste 8",
            "address_purpose": "LOCATION",
            "city": "East Alton",
            "state": "IL",
            "postal_code": "620242294",
            "country_code": "US",
            "telephone_number": "618-259-1419",
            "fax_number": "618-259-1502",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOENIG",
        "first_name": "MICHAEL",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-01",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2010003226",
            "primary": false
        },
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "MO",
            "license": "2010003226",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036136533",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1720171093",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2484440",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Caroline Isabel Koenig
• Carolyn L Koenig, MD
• Jaimie Ann Louise Koenig, M.S., CCC-SLP
• Joel S Koenig, M.D.
• Joyce Marie Koenig, MD
• Sara M Koenig, WHNP
• Shannon Kelly Koenigsfeld, PLPC
• Jeffrey R Koenitzer, MD
• Charlene Velma Koepke, CRNA
• Haley M Koepp, PMHNP-BC

• Pediatrics Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; 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.

Verify at the official NPI Registry.