Provider Demographics
NPI:1215906029
Name:GORUP, JOHN M (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:GORUP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4699
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-4699
Mailing Address - Country:US
Mailing Address - Phone:765-449-2732
Mailing Address - Fax:765-449-1196
Practice Address - Street 1:1345 UNITY PLACE
Practice Address - Street 2:SUITE 310
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5769
Practice Address - Country:US
Practice Address - Phone:765-446-5215
Practice Address - Fax:765-446-5211
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046921A207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200029859OtherRAILROAD MEDICARE
IN200146050Medicaid
IN000000110519OtherANTHEM PROVIDER NUMBER
IN1272900001Medicare NSC
IN200029859OtherRAILROAD MEDICARE
IN815150FMedicare PIN
IN815150FMedicare PIN