MEDICARE: DANIEL A. KORB 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	2084P0800X	Psychiatry Physician	5257	MT
2	2084P0804X	Child & Adolescent Psychiatry Physician	36648	CO
3	2084P0804X	Child & Adolescent Psychiatry Physician	5257	MT

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	112948	OTHER	CO	VALUE OPTIONS
3	810445794	OTHER	CO	TAX ID#

General Provider Information

NPI Number	:	1649298357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL A. KORB MD

Provider Business Mailing Address
First Line	:	75 CLAREMONT ST STE C
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-3500
Country	:	US
Telephone Number	:	406-758-5155
Fax Number	:	406-758-5166

Provider Business Practice Location Address
First Line	:	75 CLAREMONT ST STE C
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-3500
Country	:	US
Telephone Number	:	406-758-5155
Fax Number	:	406-758-5166

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	11/27/2023

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