Healthcare Provider Details

I. General information

NPI: 1912098047
Provider Name (Legal Business Name): ALPENA ORTHOPAEDIC ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 LONG RAPIDS PLAZA
ALPENA MI
49707-1394
US

IV. Provider business mailing address

401 LONG RAPIDS PLAZA
ALPENA MI
49707-1394
US

V. Phone/Fax

Practice location:
  • Phone: 989-356-9333
  • Fax: 989-356-0804
Mailing address:
  • Phone: 989-356-9333
  • Fax: 989-356-0804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberEC047605
License Number StateMI

VIII. Authorized Official

Name: DR. ERIC R CORNISH
Title or Position: PARTNER
Credential: M.D.
Phone: 989-356-9333