Provider Demographics
NPI:1467421412
Name:KOREN, MIKHAIL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MIKHAIL
Middle Name:S
Last Name:KOREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:S
Other - Last Name:KOREN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:231 SEASONS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44224
Mailing Address - Country:US
Mailing Address - Phone:330-651-5110
Mailing Address - Fax:330-650-5115
Practice Address - Street 1:231 SEASONS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44224
Practice Address - Country:US
Practice Address - Phone:330-651-5110
Practice Address - Fax:330-650-5115
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.132807207RE0101X
MI4301104355207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0267001Medicaid
PAP00365600OtherRR MEDICARE
PA7832763OtherAETNA
PA103537OtherPA MCR GROUP PTAN
PA410912OtherUPMC
PA0016067720005Medicaid
PA101420620Medicaid
PA1553098OtherGATEWAY
PA8179613OtherCIGNA
PA7832763OtherAETNA
PA1553098OtherGATEWAY