Individual
DR. VIDYA KORA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3723 FRANKLIN ST, MICHIGAN CITY, IN 46360-7310
(219) 874-3313
(219) 878-2330
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01034806
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000079480
BCBS PIN NUMBER
IN
05
—
100164230
—
IN
01
—
10783551
CAQH NUMBER
IN
Enumeration date
04/27/2006
Last updated
05/10/2023
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