Healthcare Provider Details

I. General information

NPI: 1023231677
Provider Name (Legal Business Name): ELLIOT L KORN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 DEER TRACKS TRL STE 130
SAINT LOUIS MO
63131-1854
US

IV. Provider business mailing address

1715 DEER TRACKS TRL STE 130
SAINT LOUIS MO
63131-1854
US

V. Phone/Fax

Practice location:
  • Phone: 314-567-1856
  • Fax: 314-527-2425
Mailing address:
  • Phone: 314-567-1856
  • Fax: 314-527-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ELLIOT KORN
Title or Position: MD OWNER
Credential: MD
Phone: 314-567-1856