Provider Demographics
NPI:1639149768
Name:ARNOLD, CORNELIUS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CORNELIUS
Middle Name:
Last Name:ARNOLD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9724 BANBURY PL
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-9125
Mailing Address - Country:US
Mailing Address - Phone:219-922-1202
Mailing Address - Fax:
Practice Address - Street 1:901 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2901
Practice Address - Country:US
Practice Address - Phone:219-836-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032158A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053856Medicaid
IN930128579OtherMEDICARE RAILROAD
IN100095500Medicaid
IN000000278479OtherANTHEM BCBS
IL90001082OtherIL BCBS
IND15546Medicare UPIN
IL90001082OtherIL BCBS