Healthcare Provider Details

I. General information

NPI: 1285264507
Provider Name (Legal Business Name): DR. CHARBEL RONY KORAB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2020
Last Update Date: 01/26/2020
Certification Date: 01/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 S NEWBURGH RD
WAYNE MI
48184-1002
US

IV. Provider business mailing address

2950 S NEWBURGH RD
WAYNE MI
48184-1002
US

V. Phone/Fax

Practice location:
  • Phone: 734-728-6500
  • Fax: 734-729-0969
Mailing address:
  • Phone: 734-728-6500
  • Fax: 734-729-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302035422
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: