Provider Demographics
NPI:1801846514
Name:KORT, BRET A (MD)
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:A
Last Name:KORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6285 LEHMAN DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1499
Mailing Address - Country:US
Mailing Address - Phone:719-260-7050
Mailing Address - Fax:719-260-9757
Practice Address - Street 1:6285 LEHMAN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1499
Practice Address - Country:US
Practice Address - Phone:719-260-7050
Practice Address - Fax:719-260-9757
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33462207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01334622Medicaid
COF82747Medicare UPIN
COCL9418Medicare ID - Type Unspecified