Individual
MR. RUSSELL D KORNEGOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
703 N 2ND ST, COLDWATER, OH 45828-9780
(419) 678-2168
(419) 678-8893
Mailing address
703 N 2ND ST, COLDWATER, OH 45828-9780
(419) 678-2168
(419) 678-8893
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
HMEL.11296
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000283155
ANTHEM
OH
05
—
2324701
—
OH
Enumeration date
11/28/2007
Last updated
11/28/2007
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