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NPI Code Detail

MEDICARE: JAN R KORNILOW, M.D., LLC

MEDICARE: JAN R KORNILOW, M.D., LLC
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
1207P00000XEmergency Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2DP1120OTHERINRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437183381
Entity Type Code : Organization
Provider Name (Legal Business Name) : JAN R KORNILOW, M.D., LLC
Provider Business Mailing Address
First Line : PO BOX 2347
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46206-2347
Country : US
Telephone Number : 260-969-1950
Fax Number : 260-918-2137
Provider Business Practice Location Address
First Line : 2901 W JACKSON ST
Second Line :
City : MUNCIE
State : IN
Zip : 47304-4307
Country : US
Telephone Number : 765-751-5010
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JAN R KORNILOW
Credential : M.D.
Telephone Number : 260-969-1950
Provider Enumeration Date : 07/10/2006
Last Update Date : 07/29/2014

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