MEDICARE: JOHN H MAHON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	01038212A	IN
2	207XS0106X	Orthopaedic Hand Surgery Physician	01038212A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861474801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN H MAHON M.D.

Provider Business Mailing Address
First Line	:	3245 HEALTH DR STE 100
Second Line	:
City	:	GRANGER
State	:	IN
Zip	:	46530-1380
Country	:	US
Telephone Number	:	574-647-2129
Fax Number	:	574-237-6069

Provider Business Practice Location Address
First Line	:	1815 E IRELAND RD
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46614-2845
Country	:	US
Telephone Number	:	574-647-1700
Fax Number	:	574-647-7572

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	04/04/2024

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