Basic Information
| Provider Information | |||||||||
| NPI: | 1326394925 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KORANNE | ||||||||
| FirstName: | KETAN | ||||||||
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| Credential: | M.B., B.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 S CRESCENT DR | ||||||||
| Address2: | |||||||||
| City: | MASON CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504012926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6414945300 | ||||||||
| FaxNumber: | 6414945321 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 S CRESCENT DR | ||||||||
| Address2: | |||||||||
| City: | MASON CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504012926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6414945300 | ||||||||
| FaxNumber: | 6414945321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2012 | ||||||||
| LastUpdateDate: | 04/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | BP1-0037564 | TX | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RC0001X | 44563 | IA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
No ID Information.