Individual
JOHN M DIVERIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
333 W 89TH AVE, SUITE W5, MERRILLVILLE, IN 46410-7073
(219) 755-4448
(219) 755-4454
Mailing address
333 W 89TH AVE, SUITE W5, MERRILLVILLE, IN 46410-7073
(219) 755-4448
(219) 755-4454
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
01040065A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000381584
ANTHEM
IN
05
—
200010670
—
IN
Enumeration date
07/18/2005
Last updated
08/27/2012
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