Provider Demographics
NPI:1124005319
Name:CORWIN, HAL M (MD)
Entity Type:Individual
Prefix:DR
First Name:HAL
Middle Name:M
Last Name:CORWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-238-2801
Mailing Address - Fax:502-238-2835
Practice Address - Street 1:3900 KRESGE WAY
Practice Address - Street 2:SUITE 56
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4660
Practice Address - Country:US
Practice Address - Phone:502-895-7265
Practice Address - Fax:502-897-2032
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY224612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000617816OtherANTHEM
KY64224611Medicaid
IN100373890Medicaid
KY64224611Medicaid
KY00162065Medicare PIN