Individual
DR. JAN ROMAN KORNILOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2401 W UNIVERSITY AVE, MUNCIE, IN 47303-3428
(260) 969-1950
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01046719A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000082488
BLUE CROSS/BLUE SHIELD
IN
01
—
000000626585
ANTHEM BC/BS
IN
01
—
000000658168
ANTHEM BC/BS
IN
05
—
200173100A
—
IN
01
—
P00730932
RAILROAD MEDICARE
IN
01
—
P00742238
RAILROAD MEDICARE
IN
01
—
P00841049
RAILROAD MEDICARE
IN
Enumeration date
07/20/2005
Last updated
02/08/2021
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