Provider Demographics
NPI:1225054943
Name:KORNELI, FERDINAND J (DO)
Entity Type:Individual
Prefix:
First Name:FERDINAND
Middle Name:J
Last Name:KORNELI
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 1:1200 W NORTH DOWN RIVER RD STE C
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-8024
Mailing Address - Country:US
Mailing Address - Phone:989-344-5910
Mailing Address - Fax:231-935-3463
Practice Address - Street 1:1200 W NORTH DOWN RIVER RD STE C
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-8024
Practice Address - Country:US
Practice Address - Phone:989-344-5910
Practice Address - Fax:231-935-3463
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010337207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4327831Medicaid
MI2879522Medicaid
MI2879522Medicaid
B06000025Medicare PIN
F38760Medicare UPIN