Individual
DR. LISA GUSTINE KORNELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.P.M.
Contact information
Practice address
2358 W WASHINGTON ST, WEST BEND, WI 53095-2118
(262) 335-2930
(262) 335-2931
Mailing address
2358 W WASHINGTON ST, WEST BEND, WI 53095-2118
(262) 335-2930
(262) 335-2931
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
774-025
WI
332B00000X
Durable Medical Equipment & Medical Supplies
774-025
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43225400
—
WI
Enumeration date
04/27/2006
Last updated
02/01/2022
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