Provider Demographics
NPI:1487862991
Name:CORUM, JOANNE D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:D
Last Name:CORUM
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:HC 86 BOX 1225
Mailing Address - Street 2:
Mailing Address - City:STONEY FORK
Mailing Address - State:KY
Mailing Address - Zip Code:40988-9603
Mailing Address - Country:US
Mailing Address - Phone:606-337-8115
Mailing Address - Fax:606-337-8115
Practice Address - Street 1:RR 1 BOX 173 KINGDOM COME PARKWAY
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977
Practice Address - Country:US
Practice Address - Phone:606-337-9955
Practice Address - Fax:606-337-7926
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14779208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64147796Medicaid
KY64147796Medicaid
KYEO1331Medicare UPIN