Provider Demographics
NPI:1649314584
Name:CORFMAN, RANDLE SCOTT (PHD, MD)
Entity type:Individual
Prefix:
First Name:RANDLE
Middle Name:SCOTT
Last Name:CORFMAN
Suffix:
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12000 ELM CREEK BLVD N
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7073
Mailing Address - Country:US
Mailing Address - Phone:763-494-7700
Mailing Address - Fax:763-494-7706
Practice Address - Street 1:12000 ELM CREEK BLVD N
Practice Address - Street 2:SUITE 350
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7073
Practice Address - Country:US
Practice Address - Phone:763-494-7700
Practice Address - Fax:763-494-7706
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN207VE0102X207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDCOR16154OtherBCBS-ND PROVIDER #
MN3D491-MIOtherBCBS-MN PROVIDER #
FM3D492OtherBCBS-MN PROVIDER NUMBER
NDCOR16153OtherBCBS-ND PROVIDER NUMBER
FM3D492OtherBCBS-MN PROVIDER NUMBER