MEDICARE: CRISTINE L CORNELIUS 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	207Q00000X	Family Medicine Physician	39030	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00366791	OTHER	WI	RAILROAD MEDICARE
4	528513	OTHER	WI	UGS MEDICARE
5	528514	OTHER	WI	UGS MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0852480001	OTHER	WI	DMERC

General Provider Information

NPI Number	:	1710988464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINE L CORNELIUS MD

Provider Business Mailing Address
First Line	:	301 E 2ND ST
Second Line	:
City	:	RICHLAND CENTER
State	:	WI
Zip	:	53581-1900
Country	:	US
Telephone Number	:	608-647-6161
Fax Number	:	608-647-3178

Provider Business Practice Location Address
First Line	:	150 E JEFFERSON ST
Second Line	:
City	:	SPRING GREEN
State	:	WI
Zip	:	53588-8000
Country	:	US
Telephone Number	:	608-588-7413
Fax Number	:	608-588-7609

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	01/15/2008

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Directions to “ CRISTINE L CORNELIUS MD” Practice Location

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