Individual
JUAN JOSE ORTIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
207 SPARKS AVE STE 100, JEFFERSONVILLE, IN 47130-3739
(812) 284-5411
(812) 284-0144
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01054884A
IN
207RC0000X
Cardiovascular Disease Physician
Primary
01054884A
IN
207RC0000X
Cardiovascular Disease Physician
28206
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01054884A
STATE LICENSE
IN
05
—
200281160
—
IN
01
—
28206
STATE LICENSE
KY
05
—
64282064
—
KY
Enumeration date
10/05/2005
Last updated
02/16/2024
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