Healthcare Provider Details

I. General information

NPI: 1063419968
Provider Name (Legal Business Name): JOHN P KATSAROPOULOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3365 DEER LAKE DR
SOUTH BEND IN
46614-2468
US

IV. Provider business mailing address

3365 DEER LAKE DR
SOUTH BEND IN
46614-2468
US

V. Phone/Fax

Practice location:
  • Phone: 574-276-3324
  • Fax:
Mailing address:
  • Phone: 574-276-3324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01041586A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number01045186A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: