Provider Demographics
NPI:1174685598
Name:KORDIYAK, CHRISTOPHER B (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:B
Last Name:KORDIYAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1866
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-1866
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:3200 SHORE DR
Practice Address - Street 2:SUITE 4
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4292
Practice Address - Country:US
Practice Address - Phone:715-732-8610
Practice Address - Fax:715-732-8650
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30743-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31546700Medicaid
WI31546700Medicaid
P00697649Medicare Oscar/Certification
WIWI1119001Medicare Oscar/Certification
WI000010020Medicare Oscar/Certification
WI000007310Medicare Oscar/Certification
K400121984Medicare Oscar/Certification
WI002150246Medicare Oscar/Certification
WIK400175502Medicare Oscar/Certification