Provider Demographics
NPI:1013970540
Name:KORDUS, MICHAEL J II (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:KORDUS
Suffix:II
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 1:2859 STATE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8495
Mailing Address - Country:US
Mailing Address - Phone:541-282-6505
Mailing Address - Fax:
Practice Address - Street 1:8385 DIVISION RD STE 101
Practice Address - Street 2:
Practice Address - City:WHITE CITY
Practice Address - State:OR
Practice Address - Zip Code:97503-1176
Practice Address - Country:US
Practice Address - Phone:541-826-5853
Practice Address - Fax:541-826-5843
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800938207P00000X
ORMD162875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4113343OtherBLUE SHIELD
NC1118UOtherBCBS
NCP00024602OtherRAILROAD
GA247376291BMedicaid
TN3889674Medicaid
NC891118UMedicaid
OR500686045Medicaid
TN3889674Medicare ID - Type Unspecified
TN3889674Medicaid