Provider Demographics
NPI:1023101524
Name:CORUM, MICHEAL EUGENE (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHEAL
Middle Name:EUGENE
Last Name:CORUM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 WINDHORST WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-8800
Mailing Address - Country:US
Mailing Address - Phone:317-886-6639
Mailing Address - Fax:888-547-0377
Practice Address - Street 1:1499 WINDHORST WAY STE 100
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-8800
Practice Address - Country:US
Practice Address - Phone:317-886-6639
Practice Address - Fax:888-547-0377
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL40841223G0001X
IN12013860A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice