Provider Demographics
NPI:1063148989
Name:MINES, KORY
Entity type:Individual
Prefix:
First Name:KORY
Middle Name:
Last Name:MINES
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 1:9967 DARROW PARK DR
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2689
Mailing Address - Country:US
Mailing Address - Phone:216-773-3407
Mailing Address - Fax:
Practice Address - Street 1:9967 DARROW PARK DR
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2689
Practice Address - Country:US
Practice Address - Phone:216-773-3407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty