MEDICARE: NORMAN I KORNBLATT D.P.M

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	553	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194728048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NORMAN I KORNBLATT D.P.M

Provider Business Mailing Address
First Line	:	3666 HIGHWAY 5
Second Line	:	STE 101
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30135-6940
Country	:	US
Telephone Number	:	770-942-3668
Fax Number	:	770-920-9675

Provider Business Practice Location Address
First Line	:	3666 HIGHWAY 5
Second Line	:	STE 101
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30135-6940
Country	:	US
Telephone Number	:	770-942-3668
Fax Number	:	770-920-9675

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	10/14/2008

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