Healthcare Provider Details

I. General information

NPI: 1326008772
Provider Name (Legal Business Name): JOHN MICHAEL HORN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

478 WHIRLAWAY DR STE 100
DANVILLE KY
40422-9037
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-6613
  • Fax: 859-236-2284
Mailing address:
  • Phone: 606-330-7818
  • Fax: 606-330-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24626
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: