Organization
JOHN M. DORN
Active
Other names
John M. Dorn DPM
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN M DORN DPM (OWNER)
(219) 322-4066
Entity
Organization
Contact information
Practice address
944 RICHARD RD, DYER, IN 46311-1936
(219) 322-4066
Mailing address
PO BOX 248, DYER, IN 46311-0248
(219) 322-4066
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
—
480007478
RAILROAD MEDICARE
IL
01
—
480019631
RAILROAD MEDICARE
IN
01
—
5436006
AETNA
IN
01
—
90000913
BLUE CROSS/BLUE SHIELD
IL
Enumeration date
12/18/2007
Last updated
12/18/2007
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