Healthcare Provider Details

I. General information

NPI: 1649298357
Provider Name (Legal Business Name): DANIEL A. KORB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 11/27/2023
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 CLAREMONT ST STE C
KALISPELL MT
59901-3500
US

IV. Provider business mailing address

75 CLAREMONT ST STE C
KALISPELL MT
59901-3500
US

V. Phone/Fax

Practice location:
  • Phone: 406-758-5155
  • Fax: 406-758-5166
Mailing address:
  • Phone: 406-758-5155
  • Fax: 406-758-5166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5257
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number36648
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number5257
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: