Provider Demographics
NPI:1235738733
Name:CORUM, MICHAEL JAMES
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:CORUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 2ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368-2211
Mailing Address - Country:US
Mailing Address - Phone:701-740-6875
Mailing Address - Fax:
Practice Address - Street 1:414 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:RUGBY
Practice Address - State:ND
Practice Address - Zip Code:58368-2211
Practice Address - Country:US
Practice Address - Phone:701-740-6875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant