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Individual

DR. KORNELIA G. JUERGENSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD, PHD, ABFP

Contact information

Practice address
2559 E 2450TH RD, MARSEILLES, IL 61341-9749
(815) 795-5591
(815) 795-5591
Mailing address
2559 E 2450TH RD, PO BOX 249, MARSEILLES, IL 61341-9749

Taxonomy

Speciality
Code
Description
License number
State
173000000X
Legal Medicine
036104391
IL
207Q00000X
Family Medicine Physician
Primary
036-104391
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036104391
IL
01
137710004
MEDICARE IND #
MO
05
1477535284
MO
Enumeration date
11/17/2005
Last updated
03/03/2010
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