Provider Demographics
NPI:1295936524
Name:EKLOV, CORIE MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:CORIE
Middle Name:MICHELLE
Last Name:EKLOV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 N WELLNESS DR STE 120B
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8035
Mailing Address - Country:US
Mailing Address - Phone:616-399-9522
Mailing Address - Fax:
Practice Address - Street 1:3235 N WELLNESS DR STE 120B
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8035
Practice Address - Country:US
Practice Address - Phone:616-399-9522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090024208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist