Healthcare Provider Details

I. General information

NPI: 1245280460
Provider Name (Legal Business Name): CORNELIS MILLARD ELMES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 PORTLAND AVE STE 210
ROCHESTER NY
14621-3008
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-266-2010
  • Fax: 585-266-5363
Mailing address:
  • Phone:
  • Fax: 585-922-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number41021
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberA86984
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number218698
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: