Individual
JAMES T CORNWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
900 I ST, LA PORTE, IN 46350-5533
(219) 324-1700
(219) 324-1602
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01056336A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000869604
BCBS LAPORTE
IN
05
—
200369250
—
IN
01
—
P01683483
RR MEDICARE
IN
Enumeration date
08/04/2006
Last updated
03/31/2021
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