Healthcare Provider Details

I. General information

NPI: 1922169374
Provider Name (Legal Business Name): ALEX KOR DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALEXANDER KOR

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E MAIN ST
DANVILLE IN
46122-1948
US

IV. Provider business mailing address

2705 N LEBANON ST STE 305
LEBANON IN
46052-8622
US

V. Phone/Fax

Practice location:
  • Phone: 317-718-4676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000707A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: