Provider Demographics
NPI:1043318058
Name:KORCHIK, ROBERT J (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:KORCHIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S PARK AVE
Mailing Address - Street 2:PO BOX 667
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-3612
Mailing Address - Country:US
Mailing Address - Phone:618-942-8822
Mailing Address - Fax:618-942-4477
Practice Address - Street 1:220 S PARK AVE
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3612
Practice Address - Country:US
Practice Address - Phone:618-942-8822
Practice Address - Fax:618-942-4477
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL039386OtherHEALTH ALLIANCE
IL394357OtherHEALTHLINK
IL0360640852Medicaid
ILL83860Medicare ID - Type Unspecified
IL039386OtherHEALTH ALLIANCE