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Organization
TRI LAKES PODIATRY PC
Active
Organization
TRI LAKES PODIATRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY P KORTE DPM (OWNER DOCTOR)
(417) 725-9995
Entity
Organization
Contact information
Practice address
105 S RIDGECREST AVE, NIXA, MO 65714-7807
(417) 724-3100
(417) 725-2985
Mailing address
PO BOX 870, 300 WEST MT VERNON SUITE G, NIXA, MO 65714-0870
(417) 725-9995
(417) 725-2985
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
2000165040
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00294967
RAILROAD MEDICARE
MO
Enumeration date
04/16/2007
Last updated
08/22/2020
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