Healthcare Provider Details

I. General information

NPI: 1285626317
Provider Name (Legal Business Name): ALAN RICHARD CORNFIELD D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 S WASHINGTON AVE
ROYAL OAK MI
48067-3218
US

IV. Provider business mailing address

1026 S WASHINGTON AVE
ROYAL OAK MI
48067-3218
US

V. Phone/Fax

Practice location:
  • Phone: 248-541-4311
  • Fax: 248-541-9036
Mailing address:
  • Phone: 248-541-4311
  • Fax: 248-541-9036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberAC000484
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: