Provider Demographics
NPI:1316755184
Name:INSTITUTE FOR DIABETES ENDOCRINOLOGY ADIPOSITY & LONGEVITY
Entity type:Organization
Organization Name:INSTITUTE FOR DIABETES ENDOCRINOLOGY ADIPOSITY & LONGEVITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-552-8862
Mailing Address - Street 1:1653 MERRIMAN RD STE 201D
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-5279
Mailing Address - Country:US
Mailing Address - Phone:330-552-8862
Mailing Address - Fax:330-625-5167
Practice Address - Street 1:1653 MERRIMAN RD STE 201D
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-5279
Practice Address - Country:US
Practice Address - Phone:330-552-8862
Practice Address - Fax:330-625-5167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-24
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty