Individual
EARL R KOENIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11051 HALL RD, SUITE 200, UTICA, MI 48317-5735
(586) 254-5759
(586) 254-5793
Mailing address
20952 E 12 MILE RD, SUITE 200, ST CLAIR SHORES, MI 48081-3200
(586) 771-4820
(586) 771-6620
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
4301030802
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102426
PRIORITY HEALTH
MI
01
—
340019484
RAILROAD MEDICARE
MI
01
—
4391724
AETNA
MI
01
—
5259095001
CIGNA
MI
01
—
B45210
HAP
MI
Enumeration date
04/20/2006
Last updated
07/28/2008
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