Provider Demographics
NPI:1588012959
Name:KATUBIG, CORNELIO
Entity Type:Individual
Prefix:DR
First Name:CORNELIO
Middle Name:
Last Name:KATUBIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 E JENKINS CT
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-8365
Mailing Address - Country:US
Mailing Address - Phone:352-527-3651
Mailing Address - Fax:
Practice Address - Street 1:455 E JENKINS CT
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442-8365
Practice Address - Country:US
Practice Address - Phone:352-527-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036045548207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine