Provider Demographics
NPI:1689685042
Name:CORSI, JOHN MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:CORSI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CEDAR SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917
Mailing Address - Country:US
Mailing Address - Phone:401-232-3688
Mailing Address - Fax:401-231-1140
Practice Address - Street 1:28 CEDAR SWAMP RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917
Practice Address - Country:US
Practice Address - Phone:401-232-3688
Practice Address - Fax:401-231-1140
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO371207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30593OtherBLUE CROSS
RI9003059Medicaid
R002614OtherCHAMPUS
004174OtherBLUE CHIP
RI0400393OtherUNITED HEALTH
0450860001OtherCIGNA
404261OtherTUFTS
RI30593OtherBLUE CROSS