Provider Demographics
NPI:1164464426
Name:KORBA, CHRISTIANE K (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIANE
Middle Name:K
Last Name:KORBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTIANE
Other - Middle Name:K
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:901 PATIENTS FIRST DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-4700
Mailing Address - Country:US
Mailing Address - Phone:636-390-9555
Mailing Address - Fax:636-390-0114
Practice Address - Street 1:901 PATIENTS FIRST DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4700
Practice Address - Country:US
Practice Address - Phone:636-390-9555
Practice Address - Fax:636-390-0114
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107695207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208009316Medicaid
P00067152OtherRAILROAD MEDICARE
MOP01135227OtherRAILROAD MEDICARE
MO152810078Medicare PIN
031012943Medicare PIN
MO208009316Medicaid
P00067152OtherRAILROAD MEDICARE