MEDICARE: MICHAEL D. KORENMAN 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	208600000X	Surgery Physician	E2661	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	020054134	OTHER		RAILROAD 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	:	1730114638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL D. KORENMAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 961205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-1205
Country	:	US
Telephone Number	:	817-740-8400
Fax Number	:	817-924-0177

Provider Business Practice Location Address
First Line	:	1821 8TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1304
Country	:	US
Telephone Number	:	817-927-2329
Fax Number	:	817-924-0177

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	11/03/2011

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