Individual
KENNETH CORNETTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
601 W 2ND ST, BLOOMINGTON, IN 47403-2317
(812) 353-3717
(812) 353-3713
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207RH0000X
Hematology (Internal Medicine) Physician
01033270
IN
207RH0000X
Hematology (Internal Medicine) Physician
01033270A
IN
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
01033270A
IN
207SG0201X
Clinical Genetics (M.D.) Physician
01033270
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000318026
ANTHEM PTAN
IN
01
—
000000965063
ANTHEM PTAN
IN
01
—
000001365313
ANTHEM PTAN
IN
05
—
100177180
—
IN
Enumeration date
04/24/2006
Last updated
03/06/2025
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