Basic Information
| Provider Information | |||||||||
| NPI: | 1841286770 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOENIGSBERG | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | I. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9650 GROSS POINT RD STE 4900 | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600761214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476638410 | ||||||||
| FaxNumber: | 8476761727 | ||||||||
| Practice Location | |||||||||
| Address1: | 9650 GROSS POINT RD STE 4900 | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476638410 | ||||||||
| FaxNumber: | 8476761727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2005 | ||||||||
| LastUpdateDate: | 10/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036053305 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0011X | 036053305 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | 036053305 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 234690 | 01 | IL | HARMONY HEALTH IL ID | OTHER | K47968 | 01 | IL | MEDICARE PTAN | OTHER | 036053305 | 05 | IL | MEDICAID | 282012-1 | 01 | NY | LICENSE | OTHER | 060020165 | 01 | IL | RAILROAD MEDICARE | OTHER | 1617522 | 01 | IL | BCBS | OTHER |