Individual
COREY TOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5230 E STOP 11 RD STE 250, INDIANAPOLIS, IN 46237-6399
(317) 528-8921
(317) 528-6916
Mailing address
PO BOX 781008, DETROIT, MI 48278-1008
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
RS2025-0287
NM
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11022794A
LICENSE
IN
Enumeration date
03/29/2023
Last updated
08/08/2025
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