Provider Demographics
NPI:1588613921
Name:ATTY, KORIAL J (MD)
Entity Type:Individual
Prefix:DR
First Name:KORIAL
Middle Name:J
Last Name:ATTY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:29425 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1080
Mailing Address - Country:US
Mailing Address - Phone:248-948-6900
Mailing Address - Fax:248-948-6904
Practice Address - Street 1:29425 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1080
Practice Address - Country:US
Practice Address - Phone:248-948-6900
Practice Address - Fax:248-948-6904
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-05-15
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Provider Licenses
StateLicense IDTaxonomies
MIKA036080207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2334010005OtherCIGNA
MI4188765Medicaid
MI214011OtherOMNI CARE
MIC8024OtherM-CARE
MI0635164OtherBCBS OF MICHIGAN
MI383472675OtherAETNA
MI120482-0007OtherWELLNESS PLAN
MIB47270OtherHEALTH ALLIANCE PLAN
MI0635164OtherBLUE CARE NETWORK
MI101112OtherCARE CHOICES
MI2334010005OtherCIGNA
MI120482-0007OtherWELLNESS PLAN