Provider Demographics
NPI:1720059942
Name:KORT, HEATHER MICHELLE (DO)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MICHELLE
Last Name:KORT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:M
Other - Last Name:ZACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5701 W 119TH ST
Mailing Address - Street 2:STE. 220
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3721
Mailing Address - Country:US
Mailing Address - Phone:913-498-8787
Mailing Address - Fax:913-498-1744
Practice Address - Street 1:5701 W 119TH ST
Practice Address - Street 2:STE. 220
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3721
Practice Address - Country:US
Practice Address - Phone:913-498-8787
Practice Address - Fax:913-498-1744
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004007497207RA0201X, 207R00000X, 208M00000X
KS05-31489207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207346909Medicaid
KS200374590AMedicaid
MO207346909Medicaid
KSE11D940BMedicare PIN
MOE11D940Medicare PIN