MEDICARE: DR. JAY L. KORACH M.D.

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	2085R0202X	Diagnostic Radiology Physician	036085791	IL
2	2085R0202X	Diagnostic Radiology Physician	01062709	IN

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306823570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY L. KORACH M.D.

Provider Business Mailing Address
First Line	:	7905 CALUMET
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-1215
Country	:	US
Telephone Number	:	414-455-4780
Fax Number	:	414-475-2936

Provider Business Practice Location Address
First Line	:	7905 CALUMET
Second Line	:	HAMMOND CLINIC LLC
City	:	MUNSTER
State	:	IN
Zip	:	46321-1215
Country	:	US
Telephone Number	:	219-836-5800
Fax Number	:	219-836-8073

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	10/28/2014

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