Provider Demographics
NPI:1649559204
Name:CORMAN, KEVIN MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:MICHAEL
Last Name:CORMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-6005
Mailing Address - Fax:704-316-6006
Practice Address - Street 1:1918 RANDOLPH RD STE 130
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1107
Practice Address - Country:US
Practice Address - Phone:704-316-6005
Practice Address - Fax:704-316-6006
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.003960207X00000X
PAOS018227207X00000X
NC2023-00891207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103131733Medicaid
PA103131733Medicaid