MEDICARE: DR. JONI M KOREN D.O.

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	207Q00000X	Family Medicine Physician	34003916K	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	080191715	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	421534506041	OTHER	OH	CARESOURCE
2	63489	OTHER	OH	AETNA
3	34003916	OTHER	OH	MEDICAL LICENSE
4	000000227852	OTHER	OH	ANTHEM
5	0120586	OTHER	OH	UNITED HEALTHCARE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	D0391605	OTHER	OH	HUMANA/CHOICECARE

General Provider Information

NPI Number	:	1154323368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONI M KOREN D.O.

Provider Business Mailing Address
First Line	:	2912 SPRINGBORO W
Second Line	:	STE 201
City	:	DAYTON
State	:	OH
Zip	:	45439-1674
Country	:	US
Telephone Number	:	937-297-8999
Fax Number	:	937-233-0574

Provider Business Practice Location Address
First Line	:	8701 TROY PIKE
Second Line	:	SUITE 10
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-1066
Country	:	US
Telephone Number	:	937-237-5294
Fax Number	:	937-237-4748

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	12/24/2015

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