Provider Demographics
NPI:1801862586
Name:CORPUS, JAMES THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:CORPUS
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:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-626-6161
Mailing Address - Fax:419-502-3511
Practice Address - Street 1:25200 CENTER RIDGE RD
Practice Address - Street 2:#3500
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145
Practice Address - Country:US
Practice Address - Phone:440-331-4088
Practice Address - Fax:440-331-4095
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070749C207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
341783789118OtherCARESOURCE
0113811OtherUNITED HEALTHCARE
OH2342503Medicaid
000000365164OtherANTHEM
F70749OtherSUMMACARE APEX
5886664OtherAETNA
OH4126005Medicare PIN
0113811OtherUNITED HEALTHCARE