Provider Demographics
NPI:1790990471
Name:ROBERT H CORNFIELD DPM PC
Entity Type:Organization
Organization Name:ROBERT H CORNFIELD DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:CORNFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-364-0500
Mailing Address - Street 1:6700 N ROCHESTER RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-4362
Mailing Address - Country:US
Mailing Address - Phone:248-364-0500
Mailing Address - Fax:248-364-0505
Practice Address - Street 1:6700 N ROCHESTER RD
Practice Address - Street 2:SUITE 112
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48306-4362
Practice Address - Country:US
Practice Address - Phone:248-364-0500
Practice Address - Fax:248-364-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRC001495213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3444735Medicaid
MI4856354280OtherBLUE CROSS BLUE SHIELD
MIU28845Medicare UPIN
MI0P19070Medicare PIN