Kornely Podiatry, LLC

Primary specialty

PodiatristTaxonomy code 213E00000X

License

774-025 Issued in WI

Legal business name

KORNELY PODIATRY, LLC

Practice address

2358 W Washington St
West Bend, WI 53095-2118

Phone

(262) 335-2930

Fax

(262) 335-2931

NPI assigned

May 27, 2006

Last updated

Feb 1, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Lisa G. Kornely, DPMNPI 1699732461

Title

Owner

Phone

(262) 335-2930

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lisa Gustine Kornely, D.P.M.

  • Podiatrist
  • West Bend, WI
  • NPI 1699732461
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643673600000",
    "number": "1861449720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2358 W WASHINGTON ST",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530952118",
            "telephone_number": "262-335-2930",
            "fax_number": "262-335-2931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2358 W WASHINGTON ST",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530952118",
            "telephone_number": "262-335-2930",
            "fax_number": "262-335-2931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KORNELY PODIATRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A",
        "authorized_official_last_name": "KORNELY",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-335-2930",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "WI",
            "license": "774-025",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43225400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Courtney Kohlmann
• Amber R Koll, PA-C
• Mykala Konrardy
• Michael Scott Kopecky, DDS MS
• Suzanne Kordas, LPC-IT
• Lisa Gustine Kornely, D.P.M.
• Samuel Jon Kortes
• Charlene Koslowski
• Robert F Kossow, RPH
• Morgan Koth

• Podiatrist in West Bend, WI
• Providers in West Bend, WI by specialty
• Podiatrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.