Provider Demographics
NPI:1467455170
Name:BROWNLEE, KORY (DPM)
Entity Type:Individual
Prefix:
First Name:KORY
Middle Name:
Last Name:BROWNLEE
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 1:242 INDIGO BLUE ST
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-5073
Mailing Address - Country:US
Mailing Address - Phone:614-206-7928
Mailing Address - Fax:
Practice Address - Street 1:242 INDIGO BLUE ST
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-5073
Practice Address - Country:US
Practice Address - Phone:614-206-7928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003315213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2343280Medicaid
OHP00139680OtherRAILROAD MEDICARE
OHH068020Medicare PIN