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General NPI Number Information
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NPI Number | 1134580863
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Entity Type | Individual
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Provider Name | THEODORE THOMAS KORTY DO
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Gender | Male
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Dates
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Enumeration Date | 03/08/2016
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 1449 KIMBER LN STE 102
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City | EVANSVILLE
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State | IN
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Zip | 47715-4067
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Country | US
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Telephone | 812-227-5524
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Fax | 812-476-2616
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Provider Business Mailing Address
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Address Line | 1449 KIMBER LN STE 102
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City | EVANSVILLE
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State | IN
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Zip | 47715-4067
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Country | US
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Telephone | 812-227-5524
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Fax | 812-476-2616
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | R1977
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 02005894A
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License Number State | IN
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