Provider Demographics
NPI:1184721532
Name:KORENMAN, PHILIP DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:DAVID
Last Name:KORENMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4975 PRESTON PARK BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3635
Mailing Address - Country:US
Mailing Address - Phone:972-985-4011
Mailing Address - Fax:972-985-2120
Practice Address - Street 1:4975 PRESTON PARK BLVD
Practice Address - Street 2:SUITE 790
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5164
Practice Address - Country:US
Practice Address - Phone:972-985-4011
Practice Address - Fax:972-985-2120
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG35302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88Z140Medicare ID - Type Unspecified
TXB24077Medicare UPIN