Provider Demographics
NPI:1467640300
Name:ROBERT R CORNWELL MD PC
Entity Type:Organization
Organization Name:ROBERT R CORNWELL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:CORNWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-772-7300
Mailing Address - Street 1:1901 S HEATON ST
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:IN
Mailing Address - Zip Code:46534-2325
Mailing Address - Country:US
Mailing Address - Phone:574-772-7300
Mailing Address - Fax:574-772-7301
Practice Address - Street 1:1901 S HEATON ST
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534-2325
Practice Address - Country:US
Practice Address - Phone:574-772-7300
Practice Address - Fax:574-772-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN169260Medicare PIN