MEDICARE: DEREK KORTE 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	207RG0100X	Gastroenterology Physician	5101014117	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00265563	OTHER	MI	RR MEDICARE

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	:	1346226495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK KORTE D.O.

Provider Business Mailing Address
First Line	:	3495 S CENTER RD
Second Line	:
City	:	BURTON
State	:	MI
Zip	:	48519-1455
Country	:	US
Telephone Number	:	810-424-2007
Fax Number	:	810-743-1099

Provider Business Practice Location Address
First Line	:	600 HEALTH PARK BLVD
Second Line	:	SUITE D
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2558
Country	:	US
Telephone Number	:	810-603-8400
Fax Number	:

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	01/05/2010

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