Basic Information
| Provider Information | |||||||||
| NPI: | 1467433599 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KORMAN | ||||||||
| FirstName: | HOWARD | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31157 WOODWARD AVE | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480730926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483360123 | ||||||||
| FaxNumber: | 2483363190 | ||||||||
| Practice Location | |||||||||
| Address1: | 31157 WOODWARD AVE | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483360123 | ||||||||
| FaxNumber: | 2483363190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 06/25/2018 | ||||||||
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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 | 208800000X | 4301054798 | MI | N | Allopathic & Osteopathic Physicians | Urology | 208D00000X | 63887 | MN | N | Allopathic & Osteopathic Physicians | General Practice | 208600000X | 4301054798 | MI | N | Allopathic & Osteopathic Physicians | Surgery | 208D00000X | 4301054798 | MI | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 3406313881 | 01 | MI | BCBSM INDIVIDUAL NUMBER | OTHER | 4973514 | 05 | MI | MEDICAID | 340013023 | 01 | MI | MEDICAID RAILROAD | OTHER | 3257788 | 05 | MI | MEDICAID | 5567396 | 01 | MI | AETNA | OTHER | 131397 | 01 | MI | PREFERRED CARE CHOICES | OTHER | G29155 | 01 | MI | HAP | OTHER | HK054798 | 01 | MI | BCBSM LICENSE NUMBER | OTHER | C5567 | 01 | MI | MCARE | OTHER |