Provider Demographics
NPI:1669430351
Name:KORNGUT, IRWIN STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:IRWIN
Middle Name:STEVEN
Last Name:KORNGUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8220 WALNUT HILL LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4427
Mailing Address - Country:US
Mailing Address - Phone:214-739-5505
Mailing Address - Fax:214-987-3194
Practice Address - Street 1:8220 WALNUT HILL LN
Practice Address - Street 2:SUITE 110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4427
Practice Address - Country:US
Practice Address - Phone:214-739-5505
Practice Address - Fax:214-987-3194
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE9753207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033328801Medicaid
TXB24082Medicare UPIN
TX00FH76Medicare ID - Type Unspecified