Healthcare Provider Details

I. General information

NPI: 1891891156
Provider Name (Legal Business Name): JOHN THOMAS TAYLOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 STATE ST
LA PORTE IN
46350-3112
US

IV. Provider business mailing address

2022 KELLE DR
CHESTERTON IN
46304-8708
US

V. Phone/Fax

Practice location:
  • Phone: 219-326-5700
  • Fax: 219-326-8131
Mailing address:
  • Phone: 219-364-4004
  • Fax: 219-326-2584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01027579A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: