MEDICARE: DR. ELLIOT LAWRENCE KORN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	R6E34	MO
2	207W00000X	Ophthalmology Physician	R6E34	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	R51061708	OTHER	MO	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1649267253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLIOT LAWRENCE KORN M.D.

Provider Business Mailing Address
First Line	:	1715 DEER TRACKS TRL STE 130
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1854
Country	:	US
Telephone Number	:	314-567-1856
Fax Number	:	314-527-2425

Provider Business Practice Location Address
First Line	:	1715 DEER TRACKS TRL STE 130
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1854
Country	:	US
Telephone Number	:	314-567-1856
Fax Number	:	314-527-2425

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	03/14/2022

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Directions to “ DR. ELLIOT LAWRENCE KORN M.D.” Practice Location

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