Provider Demographics
NPI:1609053511
Name:ROBERT KORENBERG MD PC
Entity Type:Organization
Organization Name:ROBERT KORENBERG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KORENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-543-8512
Mailing Address - Street 1:1821 SOUTH AVE W
Mailing Address - Street 2:STE 402
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6517
Mailing Address - Country:US
Mailing Address - Phone:406-543-8512
Mailing Address - Fax:406-541-8513
Practice Address - Street 1:1821 SOUTH AVE W
Practice Address - Street 2:STE 402
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6517
Practice Address - Country:US
Practice Address - Phone:406-543-8512
Practice Address - Fax:406-541-8513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty