Provider Demographics
NPI:1063413151
Name:CORUM, LARRY R (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:R
Last Name:CORUM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:20375 W 151ST ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7218
Mailing Address - Country:US
Mailing Address - Phone:913-780-4000
Mailing Address - Fax:913-780-4038
Practice Address - Street 1:20375 W 151ST ST
Practice Address - Street 2:SUITE 208
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7218
Practice Address - Country:US
Practice Address - Phone:913-780-4000
Practice Address - Fax:913-780-4038
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2016-01-18
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Provider Licenses
StateLicense IDTaxonomies
KS04-30533207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS34068015OtherBC/BS OF KC
KS200266340DMedicaid
KSI05488Medicare UPIN
KSKA3227001Medicare PIN