Provider Demographics
NPI:1285626317
Name:CORNFIELD, ALAN RICHARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RICHARD
Last Name:CORNFIELD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3218
Mailing Address - Country:US
Mailing Address - Phone:248-541-4311
Mailing Address - Fax:248-541-9036
Practice Address - Street 1:1026 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3218
Practice Address - Country:US
Practice Address - Phone:248-541-4311
Practice Address - Fax:248-541-9036
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAC000484213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT93466Medicare UPIN
MI0F36332001Medicare ID - Type Unspecified