Healthcare Provider Details

I. General information

NPI: 1801856497
Provider Name (Legal Business Name): MARKUS KORNBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 OAK COMMONS BLVD
KISSIMMEE FL
34741
US

IV. Provider business mailing address

604 OAK COMMONS BLVD
KISSIMMEE FL
34741
US

V. Phone/Fax

Practice location:
  • Phone: 407-846-6004
  • Fax: 407-846-1330
Mailing address:
  • Phone: 407-846-6004
  • Fax: 407-846-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME0037123
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: