Healthcare Provider Details

I. General information

NPI: 1023090016
Provider Name (Legal Business Name): JON E HORSCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HIGH PARK AVE
GOSHEN IN
46526-4810
US

IV. Provider business mailing address

PO BOX 308
MISHAWAKA IN
46546-0308
US

V. Phone/Fax

Practice location:
  • Phone: 574-533-2141
  • Fax:
Mailing address:
  • Phone: 574-273-6546
  • Fax: 574-573-5295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01042672
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: