Healthcare Provider Details

I. General information

NPI: 1831130905
Provider Name (Legal Business Name): JOHN PAUL DOHANICH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 W COLUMBIA ST
EVANSVILLE IN
47710-1757
US

IV. Provider business mailing address

2829 CHARLESTOWN CT
EVANSVILLE IN
47725-8055
US

V. Phone/Fax

Practice location:
  • Phone: 812-450-7455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number02002326A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: