Provider Demographics
NPI:1467433599
Name:KORMAN, HOWARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:J
Last Name:KORMAN
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 1:31157 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0926
Mailing Address - Country:US
Mailing Address - Phone:248-336-0123
Mailing Address - Fax:248-336-3190
Practice Address - Street 1:31157 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073
Practice Address - Country:US
Practice Address - Phone:248-336-0123
Practice Address - Fax:248-336-3190
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054798208800000X, 208600000X, 208D00000X
MN63887208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208800000XAllopathic & Osteopathic PhysiciansUrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3406313881OtherBCBSM INDIVIDUAL NUMBER
MI4973514Medicaid
MI340013023OtherMEDICAID RAILROAD
MI3257788Medicaid
MI5567396OtherAETNA
MI131397OtherPREFERRED CARE CHOICES
MIG29155OtherHAP
MIHK054798OtherBCBSM LICENSE NUMBER
MIC5567OtherMCARE
OF37635006Medicare ID - Type Unspecified
MIG29155OtherHAP
MIP41310010Medicare ID - Type Unspecified