Provider Demographics
NPI:1194745471
Name:CORNFIELD, MICHAEL I (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:I
Last Name:CORNFIELD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W CENTRAL AVE
Mailing Address - Street 2:#204
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821
Mailing Address - Country:US
Mailing Address - Phone:714-990-4422
Mailing Address - Fax:714-990-2855
Practice Address - Street 1:410 W CENTRAL AVE
Practice Address - Street 2:#204
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821
Practice Address - Country:US
Practice Address - Phone:714-990-4422
Practice Address - Fax:714-990-2855
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2059213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00E2059Medicaid
CA1194745471OtherINDIVIDUAL NPI
CA1609107366OtherNPI TYPE 2
CACV970ZOtherPTAN
CACV970ZOtherPTAN
T1160Medicare UPIN