Basic Information
| Provider Information | |||||||||
| NPI: | 1013970540 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KORDUS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2859 STATE ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975048495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412826505 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8385 DIVISION RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | WHITE CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975031176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418265853 | ||||||||
| FaxNumber: | 5418265843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2006 | ||||||||
| LastUpdateDate: | 11/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 9800938 | NC | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | MD162875 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4113343 | 01 | TN | BLUE SHIELD | OTHER | 1118U | 01 | NC | BCBS | OTHER | P00024602 | 01 | NC | RAILROAD | OTHER | 247376291B | 05 | GA | MEDICAID | 3889674 | 05 | TN | MEDICAID | 891118U | 05 | NC | MEDICAID | 500686045 | 05 | OR | MEDICAID |