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General NPI Number Information
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NPI Number | 1689203788
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Entity Type | Individual
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Provider Name | DAVID KORNELUK MD
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Gender | Male
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 425 S CHERRY ST STE 410
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City | GLENDALE
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State | CO
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Zip | 80246-1231
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Country | US
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Telephone | 303-333-3388
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Fax | 303-333-5094
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Provider Business Mailing Address
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Address Line | 425 S CHERRY ST STE 410
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City | GLENDALE
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State | CO
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Zip | 80246-1231
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.72899
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 72899
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License Number State | CO
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