Healthcare Provider Details

I. General information

NPI: 1619219102
Provider Name (Legal Business Name): MICHELLE LYNN KORN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

386 LARIMORE VALLEY DR
WILDWOOD MO
63005-6226
US

V. Phone/Fax

Practice location:
  • Phone: 816-728-8235
  • Fax:
Mailing address:
  • Phone: 816-728-8235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number301433
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number02009234A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number301433
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: