Individual
JOHN GABRIEL MAIJUB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2651 E DISCOVERY PKWY, BLOOMINGTON, IN 47408-9059
(812) 355-6900
(812) 339-1292
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01080143A
IN
2086S0129X
Vascular Surgery Physician
Primary
01080143A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090540925
MEDICARE PTAN
IN
01
—
273010006
MEDICARE PTAN
IN
05
—
300017820
—
IN
01
—
P02093002
RAILROAD PTAN
IN
Enumeration date
03/24/2010
Last updated
12/01/2023
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