Active NPI
Michael S Kobernick, MD
- Emergency Medicine Physician
- Warren, MI
National Provider Identifier
1659305076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 4301041539
- Practice address
- 11800 E 12 Mile Rd
Warren, MI 48093-3472 - Phone
- (586) 573-5052
- NPI assigned
- Jul 10, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 4301041539 | MI | Primary |
Addresses
Primary practice location
11800 E 12 Mile Rd
Warren, MI 48093-3472
Mailing address
25424 Henley Ave
Huntington Woods, MI 48070-1709
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1925040 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Henry Ford Health St. John Hospital | Past | Accepting new patients | |
| St John Macomb-Oakland Hospital | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Henry Ford St John Hospital
- Internal Medicine Physician
- Detroit, MI
- NPI 1912965088
-
- Emergency Medical Services (Emergency Medicine) Physician
- Warren, MI
- NPI 1902817620
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1226361600000",
"number": "1659305076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25424 HENLEY AVE",
"city": "HUNTINGTON WOODS",
"state": "MI",
"postal_code": "480701709"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11800 E 12 MILE RD",
"city": "WARREN",
"state": "MI",
"postal_code": "480933472",
"telephone_number": "586-573-5052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOBERNICK",
"first_name": "MICHAEL",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-10",
"last_updated": "2008-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MI",
"license": "4301041539",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1925040",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Warren, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.