Provider Demographics
NPI:1396736179
Name:KOROTKIN, STEVEN M (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:KOROTKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:32270 TELEGRAPH RD
Mailing Address - Street 2:STE 100
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-2456
Mailing Address - Country:US
Mailing Address - Phone:248-258-2888
Mailing Address - Fax:248-258-6849
Practice Address - Street 1:32270 TELEGRAPH RD
Practice Address - Street 2:STE 100
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-2456
Practice Address - Country:US
Practice Address - Phone:248-258-2888
Practice Address - Fax:248-258-6849
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301035974207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2096430Medicaid
MI2096430Medicaid
793111192Medicare PIN
OF349583061Medicare ID - Type Unspecified