Provider Demographics
NPI:1063878973
Name:MARVIN, KORI (PA)
Entity type:Individual
Prefix:
First Name:KORI
Middle Name:
Last Name:MARVIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:321 E WARWICK DR
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1084
Mailing Address - Country:US
Mailing Address - Phone:989-466-3332
Mailing Address - Fax:989-466-6805
Practice Address - Street 1:11293 N M 37
Practice Address - Street 2:
Practice Address - City:BUCKLEY
Practice Address - State:MI
Practice Address - Zip Code:49620-9593
Practice Address - Country:US
Practice Address - Phone:231-269-4185
Practice Address - Fax:231-269-4461
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601007594363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant