Provider Demographics
NPI:1609107366
Name:MICHAEL I CORNFIELD DPM INC
Entity Type:Organization
Organization Name:MICHAEL I CORNFIELD DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:CORNFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-990-4422
Mailing Address - Street 1:410 W CENTRAL AVE
Mailing Address - Street 2:204
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3014
Mailing Address - Country:US
Mailing Address - Phone:714-990-4422
Mailing Address - Fax:714-990-2855
Practice Address - Street 1:410 W CENTRAL AVE
Practice Address - Street 2:204
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3014
Practice Address - Country:US
Practice Address - Phone:714-990-4422
Practice Address - Fax:714-990-2855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2059213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00E2059Medicaid
CA1609107366OtherNPI TYPE 2
CACV970ZOtherPTAN
CA1194745471OtherINDIVIDUAL NPI
CA1609107366OtherNPI TYPE 2