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Contact Information

KORNELIA G JUERGENSEN, MD, PHD, ABFP
2559 E 2450TH RD
MARSEILLES, IL61341-9749
 Phone: 815-795-5591
 Fax: 815-795-5591
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
 

Legal Medicine

173000000X
Indicates primary specialty

NPI Profile & details for KORNELIA G JUERGENSEN · (Female)

NPI # 1477535284
Status Active
Credentials MD, PHD, ABFP
Entity Individual
Enumeration date 11/17/2005
Last updated 03/03/2010 - About 16 years ago
Sole proprietor 1 No
Identifiers
  • IL License # 036-104391
  • IL License # 036104391
  • IL Medicaid 036104391
  • MO Medicaid 1477535284
  • MO Other 137710004 MEDICARE IND #
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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