Healthcare Provider Details

I. General information

NPI: 1801868930
Provider Name (Legal Business Name): HOLLY LEE KORGES D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 MARSHALL DR STE 120
LENEXA KS
66214-9836
US

IV. Provider business mailing address

8550 MARSHALL DR STE 120
LENEXA KS
66214-9836
US

V. Phone/Fax

Practice location:
  • Phone: 913-677-3600
  • Fax: 913-432-7624
Mailing address:
  • Phone: 913-677-3600
  • Fax: 913-432-7624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number12-00334
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number2002014366
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: