Basic Information
Provider Information | |||||||||
NPI: | 1467421412 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KOREN | ||||||||
FirstName: | MIKHAIL | ||||||||
MiddleName: | S | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | KOREN | ||||||||
OtherFirstName: | MICHAEL | ||||||||
OtherMiddleName: | S | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 3033 STATE RD STE 203 | ||||||||
Address2: |   | ||||||||
City: | CUYAHOGA FALLS | ||||||||
State: | OH | ||||||||
PostalCode: | 442233600 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3309263545 | ||||||||
FaxNumber: | 3306505115 | ||||||||
Practice Location | |||||||||
Address1: | 3033 STATE RD STE 203 | ||||||||
Address2: |   | ||||||||
City: | CUYAHOGA FALLS | ||||||||
State: | OH | ||||||||
PostalCode: | 44223 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3309263545 | ||||||||
FaxNumber: | 3306505115 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/14/2006 | ||||||||
LastUpdateDate: | 06/18/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 35.132807 | OH | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
ID | Type | State | Issuer | Description | 0267001 | 05 | OH |   | MEDICAID |