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NPI Code Detail

MEDICARE: DR. CORNEL C VAN GORP MD

MEDICARE: DR. CORNEL C VAN GORP MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207XS0114XAdult Reconstructive Orthopaedic Surgery Physician35075876OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255317475
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CORNEL C VAN GORP MD
Provider Business Mailing Address
First Line : 5052 N CLINTON ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-5822
Country : US
Telephone Number : 260-484-8551
Fax Number : 260-482-5060
Provider Business Practice Location Address
First Line : 442 W HIGH ST
Second Line :
City : BRYAN
State : OH
Zip : 43506-1681
Country : US
Telephone Number : 419-636-4517
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2005
Last Update Date : 04/20/2026

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