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General NPI Number Information
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NPI Number | 1548330269
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Entity Type | Individual
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Provider Name | JOHN MICHAEL DORN DPM
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Gender | Male
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 12/15/2009
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Provider Practice Location Address
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Address Line | 944 RICHARD RD
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City | DYER
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State | IN
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Zip | 46311-1936
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Country | US
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Telephone | 219-322-4066
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Fax | 219-322-2691
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Provider Business Mailing Address
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Address Line | PO BOX 248 944 RICHARD RD.
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City | DYER
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State | IN
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Zip | 46311-0248
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Country | US
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Telephone | 219-322-4066
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Fax | 219-322-2691
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 07000629A
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License Number State | IN
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