Basic Information
| Provider Information | |||||||||
| NPI: | 1063413151 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORUM | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20375 W 151ST ST | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660617218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137804000 | ||||||||
| FaxNumber: | 9137804038 | ||||||||
| Practice Location | |||||||||
| Address1: | 20375 W 151ST ST | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660617218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137804000 | ||||||||
| FaxNumber: | 9137804038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 01/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 04-30533 | KS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 34068015 | 01 | KS | BC/BS OF KC | OTHER | 200266340D | 05 | KS | MEDICAID |