Provider Demographics
NPI:1649298357
Name:KORB, DANIEL A (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:KORB
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 1:75 CLAREMONT ST STE C
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3500
Mailing Address - Country:US
Mailing Address - Phone:406-758-5155
Mailing Address - Fax:406-758-5166
Practice Address - Street 1:75 CLAREMONT ST STE C
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3500
Practice Address - Country:US
Practice Address - Phone:406-758-5155
Practice Address - Fax:406-758-5166
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT52572084P0800X, 2084P0804X
CO366482084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01366483Medicaid
CO112948OtherVALUE OPTIONS
CO810445794OtherTAX ID#