Provider Demographics
NPI:1649963927
Name:KORTAS, JAMISON
Entity type:Individual
Prefix:
First Name:JAMISON
Middle Name:
Last Name:KORTAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 MENDOTA RD
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55077-1256
Mailing Address - Country:US
Mailing Address - Phone:612-552-3278
Mailing Address - Fax:
Practice Address - Street 1:1446 MENDOTA RD
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55077-1256
Practice Address - Country:US
Practice Address - Phone:612-552-3278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other