Provider Demographics
NPI:1851681431
Name:CORNET, PATRICK DENE
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:DENE
Last Name:CORNET
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 1:243 S SPRINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE BEACH
Mailing Address - State:IL
Mailing Address - Zip Code:60073-8139
Mailing Address - Country:US
Mailing Address - Phone:630-841-4059
Mailing Address - Fax:
Practice Address - Street 1:243 S SPRINGSIDE DR
Practice Address - Street 2:
Practice Address - City:ROUND LAKE BEACH
Practice Address - State:IL
Practice Address - Zip Code:60073-8139
Practice Address - Country:US
Practice Address - Phone:630-841-4059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program