Provider Demographics
NPI:1487754107
Name:KOROSEC, MARIAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:
Last Name:KOROSEC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22958
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44122-0958
Mailing Address - Country:US
Mailing Address - Phone:216-595-9600
Mailing Address - Fax:216-595-9601
Practice Address - Street 1:16030 E HIGH ST
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:OH
Practice Address - Zip Code:44062-9401
Practice Address - Country:US
Practice Address - Phone:440-632-0770
Practice Address - Fax:440-632-0321
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0634200Medicaid
OH0634200Medicaid