Individual
JOHN MICHAEL DORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
944 RICHARD RD, DYER, IN 46311-1936
(219) 322-4066
(219) 322-2691
Mailing address
PO BOX 248, 944 RICHARD RD., DYER, IN 46311-0248
(219) 322-4066
(219) 322-2691
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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