Provider Demographics
NPI:1568500445
Name:KORN, MATTHEW (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:KORN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20601 E DIXIE HWY
Mailing Address - Street 2:SUITE 340
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1540
Mailing Address - Country:US
Mailing Address - Phone:786-923-4000
Mailing Address - Fax:786-923-4001
Practice Address - Street 1:20601 E DIXIE HWY
Practice Address - Street 2:SUITE 340
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1540
Practice Address - Country:US
Practice Address - Phone:786-923-4000
Practice Address - Fax:786-923-4001
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8886208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI17779Medicare UPIN
FLB904AMedicare ID - Type Unspecified