Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD35900 | MO |
Y | 2080P0214X | Pediatric Pulmonologist | 35900 | MO |
NPI | 1407893142 |
---|---|
Provider Name | Peter Konig |
First Address | Kansas City, MO 64184-3966 |
Second Address | Columbia, MO 65201-6626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102525 | HEALTHLINK (01) | MO |
200528602 | (05) | MO |
2086740001 | KANSAS MEDICAID (01) | KS |
4809002 | UNITED HEALTHCARE (01) | MO |
6114 | BLUE SHIELD/BLUE CHOICE (01) | MO |
A60551 | (02) | MO |