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General NPI Number Information
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NPI Number | 1538133863
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Entity Type | Individual
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Provider Name | JOHN MICHAEL GORMLEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 03/08/2012
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Provider Practice Location Address
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Address Line | 3900 KRESGE WAY SUITE 51-A
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City | LOUISVILLE
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State | KY
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Zip | 40207-4660
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Country | US
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Telephone | 502-891-8981
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Fax | 502-891-4548
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Provider Business Mailing Address
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Address Line | PO BOX 950202
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City | LOUISVILLE
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State | KY
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Zip | 40295-0202
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Country | US
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Telephone | 502-272-5100
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Fax | 502-272-5114
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 35530
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License Number State | KY
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