Provider Demographics
NPI:1063949246
Name:EMMONS, APRIL MICHELE KORNELI (DO)
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:MICHELE KORNELI
Last Name:EMMONS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:APRIL
Other - Middle Name:MICHELE
Other - Last Name:KORNELI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1234 NAPIER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2112
Mailing Address - Country:US
Mailing Address - Phone:269-983-8172
Mailing Address - Fax:269-985-4535
Practice Address - Street 1:1234 NAPIER AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2112
Practice Address - Country:US
Practice Address - Phone:269-983-8172
Practice Address - Fax:269-985-4535
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151011840390200000X
MI5101025689207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program