MEDICARE: DR. WAYNE J KORNAS 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	207P00000X	Emergency Medicine Physician	01040882A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01040882A	OTHER	IN	IN LICENSE
2	01040882B	OTHER	IN	CSR

General Provider Information

NPI Number	:	1558472225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE J KORNAS MD

Provider Business Mailing Address
First Line	:	PO BOX 4777
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47402-4777
Country	:	US
Telephone Number	:	812-336-1690
Fax Number	:	812-349-1311

Provider Business Practice Location Address
First Line	:	992 N MITTHOEFFER RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-2622
Country	:	US
Telephone Number	:	317-899-5546
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	03/07/2023

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