MEDICARE: KIM J CORL

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1043531486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM J CORL

Provider Business Mailing Address
First Line	:	5685 BLIFFERT ST
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34287-2874
Country	:	US
Telephone Number	:	941-445-8232
Fax Number	:

Provider Business Practice Location Address
First Line	:	5685 BLIFFERT ST
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34287-2874
Country	:	US
Telephone Number	:	941-445-8232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	06/21/2010

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Directions to “ KIM J CORL ” Practice Location

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