Provider Demographics
NPI:1386677086
Name:KORNEFFEL, MEREDITH LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:LEIGH
Last Name:KORNEFFEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 INVESTMENT DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-6365
Mailing Address - Country:US
Mailing Address - Phone:248-267-5000
Mailing Address - Fax:248-267-5001
Practice Address - Street 1:4600 INVESTMENT DR
Practice Address - Street 2:SUITE 300
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-6365
Practice Address - Country:US
Practice Address - Phone:248-267-5000
Practice Address - Fax:248-267-5001
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36116069207R00000X
MI4301101219207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI7046OtherMEDICARE
ILI56882Medicare UPIN
IL036116069Medicaid