Healthcare Provider Details

I. General information

NPI: 1134580863
Provider Name (Legal Business Name): THEODORE THOMAS KORTY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1449 KIMBER LN STE 102
EVANSVILLE IN
47715-4067
US

IV. Provider business mailing address

1449 KIMBER LN STE 102
EVANSVILLE IN
47715-4067
US

V. Phone/Fax

Practice location:
  • Phone: 812-227-5524
  • Fax: 812-476-2616
Mailing address:
  • Phone: 812-227-5524
  • Fax: 812-476-2616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberR1977
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number02005894A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: