MEDICARE: KENNETH RICHARD KORZEC MD

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	207Y00000X	Otolaryngology Physician	K1510	TX

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	:	1548200850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH RICHARD KORZEC MD

Provider Business Mailing Address
First Line	:	5959 GATEWAY WEST
Second Line	:	STE 120
City	:	EL PASO
State	:	TX
Zip	:	79925-3315
Country	:	US
Telephone Number	:	915-779-1716
Fax Number	:	915-771-6496

Provider Business Practice Location Address
First Line	:	5959 GATEWAY WEST
Second Line	:	STE 160
City	:	EL PASO
State	:	TX
Zip	:	79925-3315
Country	:	US
Telephone Number	:	915-779-5866
Fax Number	:	915-771-6558

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	09/29/2011

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