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Individual

WAYNE T CORNBLATH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1000 WALL ST, ANN ARBOR, MI 48105-1912
(734) 764-4190
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
4301054843
MI
2084N0400X
Neurology Physician
Primary
4301054843
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1997657
MI
Enumeration date
08/04/2006
Last updated
11/11/2019
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