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Individual
JOHN MICHAEL DORN
Active
Individual
JOHN MICHAEL DORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07000629A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000095590
ANTHEM
IN
05
—
100202200
—
IN
01
—
5436006
AETNA
IN
01
—
60001634
BCBS OF IL FOR IL OFFICE
IL
01
—
90000913
BCBS OF IL FOR IN OFFICE
IL
Enumeration date
11/09/2006
Last updated
12/15/2009
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