Healthcare Provider Details

I. General information

NPI: 1801242177
Provider Name (Legal Business Name): KAITLYN KORN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 KOLBE RD
LORAIN OH
44053-1611
US

IV. Provider business mailing address

20000 HARVARD AVE
WARRENSVILLE HEIGHTS OH
44122-6805
US

V. Phone/Fax

Practice location:
  • Phone: 740-707-4235
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.013835
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34.013835
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: