Provider Demographics
NPI:1932112620
Name:CORNERSTONE PULMONARY AND CRITICAL CARE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:CORNERSTONE PULMONARY AND CRITICAL CARE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MODUPE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEHINDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-444-8686
Mailing Address - Street 1:PO BOX 748
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37088-0748
Mailing Address - Country:US
Mailing Address - Phone:615-444-8686
Mailing Address - Fax:615-444-7793
Practice Address - Street 1:1424 BADDOUR PARKWAY
Practice Address - Street 2:H
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087
Practice Address - Country:US
Practice Address - Phone:615-444-8686
Practice Address - Fax:615-444-7793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40614207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG70017Medicare UPIN