MEDICARE: ELLIOT L KORN MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023231677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLIOT L KORN MD INC

Provider Business Mailing Address
First Line	:	1715 DEER TRACKS TRL STE 130
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1854
Country	:	US
Telephone Number	:	314-567-1856
Fax Number	:	314-527-2425

Provider Business Practice Location Address
First Line	:	1715 DEER TRACKS TRL STE 130
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1854
Country	:	US
Telephone Number	:	314-567-1856
Fax Number	:	314-527-2425

Authorized Official
Title or Position	:	MD OWNER
Name	:	DR. ELLIOT KORN
Credential	:	MD
Telephone Number	:	314-567-1856

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	03/23/2022

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Directions to “ELLIOT L KORN MD INC ” Practice Location

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