Healthcare Provider Details

I. General information

NPI: 1609107366
Provider Name (Legal Business Name): MICHAEL I CORNFIELD DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W CENTRAL AVE 204
BREA CA
92821-3014
US

IV. Provider business mailing address

410 W CENTRAL AVE 204
BREA CA
92821-3014
US

V. Phone/Fax

Practice location:
  • Phone: 714-990-4422
  • Fax: 714-990-2855
Mailing address:
  • Phone: 714-990-4422
  • Fax: 714-990-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE2059
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL I CORNFIELD
Title or Position: OWNER
Credential: MD
Phone: 714-990-4422