Healthcare Provider Details

I. General information

NPI: 1578676235
Provider Name (Legal Business Name): JOEL S KOENIG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N. BALLAS ROAD SUITE 141
ST. LOUIS MO
63131
US

IV. Provider business mailing address

3009 N BALLAS RD STE 141
SAINT LOUIS MO
63131-2322
US

V. Phone/Fax

Practice location:
  • Phone: 314-994-0209
  • Fax: 314-994-9130
Mailing address:
  • Phone: 314-994-0209
  • Fax: 314-994-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMOR7D83
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: