Healthcare Provider Details

I. General information

NPI: 1235494089
Provider Name (Legal Business Name): MANISHA KAK KORB M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4631 N CONGRESS AVE STE 200
WEST PALM BEACH FL
33407-3234
US

IV. Provider business mailing address

4631 N CONGRESS AVE STE 200
WEST PALM BEACH FL
33407-3234
US

V. Phone/Fax

Practice location:
  • Phone: 561-845-0500
  • Fax: 561-296-1101
Mailing address:
  • Phone: 561-845-0500
  • Fax: 561-296-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License NumberME169108
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: