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General NPI Number Information
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NPI Number | 1609042282
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Entity Type | Organization
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Legal Business Name | ROBERT A CORNETTE PH D P C
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Dates
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Enumeration Date | 05/05/2008
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Last Update Date | 12/29/2008
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Provider Practice Location Address
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Address Line | 29260 FRANKLIN ROAD SUITE 101
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1182
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Country | US
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Telephone | 248-569-5268
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Fax | 248-569-1291
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Provider Business Mailing Address
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Address Line | 29260 FRANKLIN RD SUITE 101
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1161
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Country | US
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Telephone | 248-569-5268
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Fax | 248-569-1291
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Authorized Official
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Title or Position | OFFICER
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Name | DR. ROBERT ALLAN CORNETTE
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Credential | PH D
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Telephone | 248-569-5268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | RC000724
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License Number State | MI
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