Provider Demographics
NPI:1578617700
Name:FREY, KORY A (MD)
Entity Type:Individual
Prefix:DR
First Name:KORY
Middle Name:A
Last Name:FREY
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 1:7633 GANSER WAY
Mailing Address - Street 2:STE. 204
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-2092
Mailing Address - Country:US
Mailing Address - Phone:608-829-1800
Mailing Address - Fax:608-829-1885
Practice Address - Street 1:7633 GANSER WAY
Practice Address - Street 2:STE. 204
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2092
Practice Address - Country:US
Practice Address - Phone:608-829-1800
Practice Address - Fax:608-829-1885
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND97602084P0800X
WI42310-202084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDP00201213OtherRR MEDICARE
WI830400014Medicare UPIN
NDI12202Medicare UPIN
NDP00201213OtherRR MEDICARE
ND13189Medicare ID - Type Unspecified
NDN24723Medicare ID - Type Unspecified