Healthcare Provider Details

I. General information

NPI: 1306841309
Provider Name (Legal Business Name): CORY SCOTT NEUMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 MICHIGAN AVENUE STE 270
LOGANSPORT IN
46947-1530
US

IV. Provider business mailing address

1201 MICHIGAN AVENUE STE 270
LOGANSPORT IN
46947-1530
US

V. Phone/Fax

Practice location:
  • Phone: 574-722-4921
  • Fax: 574-739-0520
Mailing address:
  • Phone: 574-722-4921
  • Fax: 574-739-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01043376A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: