Provider Demographics
NPI:1811412729
Name:CORNUCOPIA STAFFING SOLUTIONS CORP
Entity Type:Organization
Organization Name:CORNUCOPIA STAFFING SOLUTIONS CORP
Other - Org Name:CORNUCOPIA HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CORPIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-375-3937
Mailing Address - Street 1:100 ILLINOIS ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1867
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 EXECUTIVE DR.
Practice Address - Street 2:ST 305-307
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-6050
Practice Address - Country:US
Practice Address - Phone:866-375-3937
Practice Address - Fax:312-488-3637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-11
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty