Provider Demographics
NPI:1639402258
Name:KORKIGIAN, SHANT ARA (DO)
Entity Type:Individual
Prefix:DR
First Name:SHANT
Middle Name:ARA
Last Name:KORKIGIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:25500 MEADOWBROOK RD STE 220
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1882
Mailing Address - Country:US
Mailing Address - Phone:248-477-7020
Mailing Address - Fax:248-522-0138
Practice Address - Street 1:25500 MEADOWBROOK RD STE 220
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375
Practice Address - Country:US
Practice Address - Phone:248-477-7020
Practice Address - Fax:248-477-2440
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2021-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101018420207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery