Provider Demographics
NPI:1801868930
Name:KORGES, HOLLY LEE (DPM)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:LEE
Last Name:KORGES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 MARSHALL DR STE 120
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-9836
Mailing Address - Country:US
Mailing Address - Phone:913-677-3600
Mailing Address - Fax:913-432-7624
Practice Address - Street 1:8550 MARSHALL DR STE 120
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-9836
Practice Address - Country:US
Practice Address - Phone:913-677-3600
Practice Address - Fax:913-432-7624
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00334213E00000X
MO2002014366213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
B38C359Medicare ID - Type Unspecified
MOP00102126Medicare PIN
U94964Medicare UPIN