Provider Demographics
NPI:1306027842
Name:KOBERNICK, AARON (MD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:KOBERNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W BIG BEAVER RD STE 107
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3522
Mailing Address - Country:US
Mailing Address - Phone:248-689-1000
Mailing Address - Fax:
Practice Address - Street 1:48801 ROMEO PLANK RD STE 103A
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-2165
Practice Address - Country:US
Practice Address - Phone:248-689-1000
Practice Address - Fax:248-689-5711
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9717129-1205207KA0200X, 207K00000X
LAMD.201983207R00000X, 208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program