Provider Demographics
NPI:1760298251
Name:CORNELL, JACK CHAMPNEY
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:CHAMPNEY
Last Name:CORNELL
Suffix:
Gender:M
Credentials:
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Mailing Address - Street 1:15371 HEMLOCK POINT RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-3801
Mailing Address - Country:US
Mailing Address - Phone:440-223-8848
Mailing Address - Fax:
Practice Address - Street 1:1120 POLARIS PKWY STE 105A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-4042
Practice Address - Country:US
Practice Address - Phone:614-505-0388
Practice Address - Fax:855-734-2645
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)