Provider Demographics
NPI:1710058375
Name:GEORGE J. KORKOS M.D.S.C
Entity Type:Organization
Organization Name:GEORGE J. KORKOS M.D.S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLASTIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KORKOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-970-5600
Mailing Address - Street 1:N4W22370 BLUEMOUND RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1683
Mailing Address - Country:US
Mailing Address - Phone:262-970-5600
Mailing Address - Fax:262-970-5950
Practice Address - Street 1:N4W22370 BLUEMOUND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1683
Practice Address - Country:US
Practice Address - Phone:262-970-5600
Practice Address - Fax:262-970-5950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13791208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30947500Medicaid
WIB54282Medicare UPIN
WI30947500Medicaid