Provider Demographics
NPI:1467676163
Name:KORSTEN, MARLIES W (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLIES
Middle Name:W
Last Name:KORSTEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 N. MILLER ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85052
Mailing Address - Country:US
Mailing Address - Phone:480-941-1952
Mailing Address - Fax:480-941-0610
Practice Address - Street 1:4300 N MILLER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3619
Practice Address - Country:US
Practice Address - Phone:480-941-1952
Practice Address - Fax:480-941-0610
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20884103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)