Provider Demographics
NPI:1306823570
Name:KORACH, JAY L (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:L
Last Name:KORACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7905 CALUMET
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1215
Mailing Address - Country:US
Mailing Address - Phone:414-455-4780
Mailing Address - Fax:414-475-2936
Practice Address - Street 1:7905 CALUMET
Practice Address - Street 2:HAMMOND CLINIC LLC
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1215
Practice Address - Country:US
Practice Address - Phone:219-836-5800
Practice Address - Fax:219-836-8073
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360857912085R0202X
IN010627092085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200863860Medicaid
IL036085791Medicaid
ILG34411Medicare UPIN
IN200863860Medicaid