Healthcare Provider Details

I. General information

NPI: 1467433599
Provider Name (Legal Business Name): HOWARD J KORMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31157 WOODWARD AVE
ROYAL OAK MI
48073
US

IV. Provider business mailing address

31157 WOODWARD AVE
ROYAL OAK MI
48073-0926
US

V. Phone/Fax

Practice location:
  • Phone: 248-336-0123
  • Fax: 248-336-3190
Mailing address:
  • Phone: 248-336-0123
  • Fax: 248-336-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301054798
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number63887
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301054798
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301054798
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: