Individual
MR. BLAINE MICHAEL CORNELIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
619 10TH ST, GOTHENBURG, NE 69138-2063
(308) 537-3674
(308) 537-3675
Mailing address
PO BOX 389, GOTHENBURG, NE 69138-0389
(308) 537-3674
(308) 537-3674
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1251
NE
Other
Enumeration date
05/19/2006
Last updated
01/31/2013
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