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General NPI Number Information
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NPI Number | 1689645707
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Entity Type | Individual
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Provider Name | JOHN LOUIS BORMANN MD
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Gender | Male
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Dates
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Enumeration Date | 01/27/2006
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 7910 W JEFFERSON BLVD STE 108
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City | FORT WAYNE
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State | IN
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Zip | 46804-4159
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Country | US
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Telephone | 260-436-0800
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Fax | 260-483-1911
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Provider Business Mailing Address
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Address Line | PO BOX 749495
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City | ATLANTA
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State | GA
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Zip | 30374-9495
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Country | US
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Telephone | 855-963-2100
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Fax | 239-236-2775
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 01042016
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License Number State | IN
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