Healthcare Provider Details

I. General information

NPI: 1578024071
Provider Name (Legal Business Name): COREY HOMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JOHN ST # 74
KALAMAZOO MI
49007-5341
US

IV. Provider business mailing address

3901 RAINBOW BLVD # MS 2027
KANSAS CITY KS
66160-8500
US

V. Phone/Fax

Practice location:
  • Phone: 269-341-8481
  • Fax:
Mailing address:
  • Phone: 913-588-6050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301506878
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: