Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | 01033270 | IN |
Y | 207RH0000X | Hematologist | 01033270A | IN |
N | 207RH0002X | Hospice and Palliative Medicine | 01033270A | IN |
N | 207SG0201X | Clinical Genetics (M.D.) | 01033270 | IN |
NPI | 1699731109 |
---|---|
Provider Name | Kenneth Cornetta |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Bloomington, IN 47403-2317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2006 |
Last Update Date | 23/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100177180 | (05) | IN |
B29568 | (02) | IN |