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General NPI Number Information
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NPI Number | 1639170517
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Entity Type | Individual
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Provider Name | ERIC ROBERT CORNISH M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 12/13/2012
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Provider Practice Location Address
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Address Line | 401 LONG RAPIDS PLZ
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City | ALPENA
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State | MI
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Zip | 49707-1394
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Country | US
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Telephone | 989-356-9333
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Fax | 989-356-0804
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Provider Business Mailing Address
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Address Line | 1501 W CHISHOLM ST
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City | ALPENA
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State | MI
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Zip | 49707-1401
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Country | US
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Telephone | 989-356-9333
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Fax | 989-356-0804
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 4301047605
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License Number State | MI
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