Provider Demographics
NPI:1932785847
Name:KORNAS, MICHAEL R (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:KORNAS
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20216 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3733
Mailing Address - Country:US
Mailing Address - Phone:586-329-8052
Mailing Address - Fax:
Practice Address - Street 1:18001 E 10 MILE RD STE 1
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-3983
Practice Address - Country:US
Practice Address - Phone:586-218-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704316009363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care