Martin Kornblum

Primary specialty

Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X

License

4301063387 Issued in MI

Practice address

11885 E 12 Mile Rd
200B
Warren, MI 48093-3474

Phone

(586) 582-7070

Fax

(586) 582-7066

NPI assigned

Oct 20, 2005

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: mkornblum37549@direct.trinity-health.org

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.

• Clear Imaging, LLC.

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Sterling Heights, MI
  • NPI 1457685257
  NPD
• Instant Imaging LLC

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Livonia, MI
  • NPI 1326418013
  NPD
• Instant Imaging LLC

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Troy, MI
  • NPI 1952263824
  NPD
• Ascension Medical Group Michigan

  dba Henry Ford Semi Medical Group

  • Orthopaedic Surgery Physician
  • Warren, MI
  • NPI 1023041852

  Orthopaedic Surgery of the Spine

  NPD (past)
• Mendelson Orthopedics PC

  • Orthopaedic Surgery Physician
  • Livonia, MI
  • NPI 1720153463
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679562722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43800 GARFIELD RD",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480381136",
            "telephone_number": "800-848-0202",
            "fax_number": "586-226-6949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11885 E 12 MILE RD",
            "address_2": "200B",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933474",
            "telephone_number": "586-582-7070",
            "fax_number": "586-582-7066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORNBLUM",
        "first_name": "MARTIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "MI",
            "license": "4301063387",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4209319",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cassie Tominna Konja, D.O.
• Jessica Renee Konkolesky, LBSW
• Margaret Konsza, MD
• John Kopacz, RPH
• Alan Korki, PHARMACIST
• Bernadette Kosir, OTR/L
• Sylvia Kostro
• Josef Kotermanski, NP-C
• Bindiya D Kothari, RPH
• Ilya Kott, M.D.

• Orthopaedic Surgery of the Spine Physician in Warren, MI
• Providers in Warren, MI by specialty
• Orthopaedic Surgery of the Spine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.