Basic Information
| Provider Information | |||||||||
| NPI: | 1306841309 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEUMANN | ||||||||
| FirstName: | CORY | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 MICHIGAN AVENUE | ||||||||
| Address2: | STE 270 | ||||||||
| City: | LOGANSPORT | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469471530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5747224921 | ||||||||
| FaxNumber: | 5747390520 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 MICHIGAN AVENUE | ||||||||
| Address2: | STE 270 | ||||||||
| City: | LOGANSPORT | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469471530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5747224921 | ||||||||
| FaxNumber: | 5747390520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 08/01/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01043376A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000090997 | 01 | IN | ANTHEM BLUE CROSS | OTHER | 4637632 | 01 | IN | AETNA | OTHER | 9195323002 | 01 | IN | CIGNA | OTHER | 200033340A | 05 | IN | MEDICAID | 080069248 | 01 | MEDICARE RAILROAD | OTHER |