Provider Demographics
NPI:1215376058
Name:MISKIN, KORY DEE (DPM)
Entity Type:Individual
Prefix:
First Name:KORY
Middle Name:DEE
Last Name:MISKIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 SW REGIONAL AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72713-9256
Mailing Address - Country:US
Mailing Address - Phone:479-553-2664
Mailing Address - Fax:479-553-2536
Practice Address - Street 1:601 SW REGIONAL AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72713-9256
Practice Address - Country:US
Practice Address - Phone:479-553-2664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN41000291A213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR217669717Medicaid
P01765552OtherRR MEDICARE
OK200681640AMedicaid