Provider Demographics
NPI:1073595963
Name:KORIS, DAVID R (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:KORIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:29099 HEALTH CAMPUS DR
Mailing Address - Street 2:SUITE 345
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5200
Mailing Address - Country:US
Mailing Address - Phone:440-835-6122
Mailing Address - Fax:440-899-4355
Practice Address - Street 1:29099 HEALTH CAMPUS DR
Practice Address - Street 2:SUITE 345
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5200
Practice Address - Country:US
Practice Address - Phone:440-835-6122
Practice Address - Fax:440-899-4355
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-001635213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1073595963OtherNPI
OH1073595963OtherNPI
0374572Medicare ID - Type Unspecified
OHT80377Medicare UPIN