Healthcare Provider Details

I. General information

NPI: 1285753301
Provider Name (Legal Business Name): KORY D KOERNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE INTERNAL MEDICINE HOSPITALIST DIVISION
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE INTERNAL MEDICINE HOSPITALIST DIVISION
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-0350
  • Fax: 414-805-0988
Mailing address:
  • Phone: 414-955-0350
  • Fax: 414-805-0988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number53436
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number53436
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: