MEDICARE: DR. CRAIG ALLEN KORNICK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician	ME82614	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5849952001	OTHER	FL	CIGNA
2	217227	OTHER	FL	HEALTHEASE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	3046289	OTHER	FL	AETNA
5	01896	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1194722512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG ALLEN KORNICK MD

Provider Business Mailing Address
First Line	:	7207 GOLDEN WINGS ROAD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-2004
Country	:	US
Telephone Number	:	904-389-1010
Fax Number	:	904-389-1082

Provider Business Practice Location Address
First Line	:	7207 GOLDEN WINGS ROAD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244
Country	:	US
Telephone Number	:	904-389-1010
Fax Number	:	904-389-1082

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	02/24/2017

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