Organization
JAN R KORNILOW, M.D., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAN R KORNILOW M.D. (OWNER)
(260) 969-1950
Entity
Organization
Contact information
Practice address
2901 W JACKSON ST, MUNCIE, IN 47304-4307
(765) 751-5010
Mailing address
PO BOX 2347, INDIANAPOLIS, IN 46206-2347
(260) 969-1950
(260) 918-2137
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200814160A
—
IN
01
—
DP1120
RAILROAD MEDICARE
IN
Enumeration date
07/10/2006
Last updated
07/29/2014
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