Provider Demographics
NPI:1164044673
Name:KORNEFFEL, ANDREW JAMES (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:KORNEFFEL
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:SPARROW HOSPITAL- GME OFFICE
Mailing Address - Street 2:1215 E MICHIGAN AVE
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912
Mailing Address - Country:US
Mailing Address - Phone:517-364-2583
Mailing Address - Fax:
Practice Address - Street 1:SPARROW HEALTH SYSTEMS
Practice Address - Street 2:1215 E MICHIGAN AVENUE
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912
Practice Address - Country:US
Practice Address - Phone:517-364-2583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151014511207P00000X
MI5101027257207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine