Provider Demographics
NPI:1245687979
Name:CORNELIO P. KATUBIG CHARTERED
Entity type:Organization
Organization Name:CORNELIO P. KATUBIG CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORNELIO
Authorized Official - Middle Name:P
Authorized Official - Last Name:KATUBIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-527-3651
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036045548291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory