Healthcare Provider Details

I. General information

NPI: 1215906029
Provider Name (Legal Business Name): JOHN M GORUP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 UNITY PL STE 310
LAFAYETTE IN
47905-5769
US

IV. Provider business mailing address

13225 N MERIDIAN ST
CARMEL IN
46032-5480
US

V. Phone/Fax

Practice location:
  • Phone: 765-446-5210
  • Fax: 765-446-5211
Mailing address:
  • Phone: 317-228-7000
  • Fax: 317-228-2321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number01046921A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: