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General NPI Number Information
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NPI Number | 1588012959
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Entity Type | Individual
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Provider Name | DR. CORNELIO KATUBIG
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Gender | Male
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 455 E JENKINS CT
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City | HERNANDO
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State | FL
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Zip | 34442-8365
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Country | US
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Telephone | 352-527-3651
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Fax |
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Provider Business Mailing Address
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Address Line | 455 E JENKINS CT
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City | HERNANDO
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State | FL
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Zip | 34442-8365
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Country | US
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Telephone | 352-527-3651
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | 036045548
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License Number State | IL
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