Juergensen, Kornelia G.

Juergensen, Kornelia G. is an individual health care provider with primary practice located at 2559 E 2450Th Rd , Marseilles IL 61341-9749. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Legal Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Juergensen, Kornelia G. can be contacted via phone (815) 795-5591.

Contact Information

Primary practice address
2559 E 2450Th Rd Marseilles IL 61341-9749
Phone: (815) 795-5591
Fax: (815) 795-5591
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Legal Medicine 173000000X 036104391 Illinois
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036-104391 Illinois

Profile Details

NPI number 1477535284
LBN Legal business name Juergensen, Kornelia G.
Credentials MD, PHD, ABFP
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 17th, 2005
Last updated Mar 3rd, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1477535284 NPPES
Illinois MEDICAID 036104391
Illinois MEDICAID 1477535284
Illinois Other 137710004

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