Provider Demographics
NPI:1386696896
Name:KORT, KARA C (MD)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:C
Last Name:KORT
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Gender:F
Credentials:MD
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Mailing Address - Street 1:5112 WEST TAFT ROAD
Mailing Address - Street 2:SUITE L
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088
Mailing Address - Country:US
Mailing Address - Phone:315-744-1865
Mailing Address - Fax:315-452-2510
Practice Address - Street 1:4117 MEDICAL CENTER DRIVE
Practice Address - Street 2:POD A
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066
Practice Address - Country:US
Practice Address - Phone:315-744-1557
Practice Address - Fax:315-329-4970
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-07-29
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Provider Licenses
StateLicense IDTaxonomies
NY213938208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01978481Medicaid
NY01978481Medicaid
NYBB7738Medicare PIN