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General NPI Number Information
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NPI Number | 1659305076
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Entity Type | Individual
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Provider Name | MICHAEL S KOBERNICK MD
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | 11800 E 12 MILE RD
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City | WARREN
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State | MI
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Zip | 48093-3472
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Country | US
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Telephone | 586-573-5052
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Fax |
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Provider Business Mailing Address
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Address Line | 25424 HENLEY AVE
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City | HUNTINGTON WOODS
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State | MI
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Zip | 48070-1709
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Country | US
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Telephone |
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 4301041539
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License Number State | MI
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