Individual
DR. JEAN MARIE CORNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3365 S 103RD ST STE 100, MILWAUKEE, WI 53227-4108
(414) 321-3951
(414) 321-8307
Mailing address
739 E BEAUMONT AVE, MILWAUKEE, WI 53217-4812
(414) 763-4027
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
50961-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
48367
—
LA
Enumeration date
10/09/2007
Last updated
11/27/2007
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