Healthcare Provider Details

I. General information

NPI: 1801244827
Provider Name (Legal Business Name): RYAN JAMES O'ROURKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 E IRELAND RD
SOUTH BEND IN
46614-2845
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-1700
  • Fax: 574-647-7572
Mailing address:
  • Phone: 574-647-1840
  • Fax: 702-734-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01087518A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number125.068130
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301510024
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number20262
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: