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Individual
EDWIN T KORNOELJE
Active
Individual
EDWIN T KORNOELJE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
5101012620
MI
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
5101012620
MI
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
5101012620
MI
Other
Enumeration date
04/11/2006
Last updated
12/05/2017
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