Provider Demographics
NPI:1598025124
Name:KORETZ, LESLIE S (DO)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:S
Last Name:KORETZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 HENDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2868
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:146 NESBITT RDG
Practice Address - Street 2:
Practice Address - City:LAKE LURE
Practice Address - State:NC
Practice Address - Zip Code:28746
Practice Address - Country:US
Practice Address - Phone:828-625-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020164207Q00000X
NC2015-01792207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine