Healthcare Provider Details

I. General information

NPI: 1164044673
Provider Name (Legal Business Name): ANDREW JAMES KORNEFFEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 08/03/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SPARROW HEALTH SYSTEMS 1215 E MICHIGAN AVENUE
LANSING MI
48912
US

IV. Provider business mailing address

SPARROW HOSPITAL- GME OFFICE 1215 E MICHIGAN AVE
LANSING MI
48912
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-2583
  • Fax:
Mailing address:
  • Phone: 517-364-2583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5151014511
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101027257
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: