Provider Demographics
NPI:1184653081
Name:HORAN, JOHN WILLIAM PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM PATRICK
Last Name:HORAN
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 1:1040 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948-1931
Mailing Address - Country:US
Mailing Address - Phone:608-847-5000
Mailing Address - Fax:608-847-9755
Practice Address - Street 1:1040 DIVISION ST
Practice Address - Street 2:
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948-1931
Practice Address - Country:US
Practice Address - Phone:608-847-5000
Practice Address - Fax:608-847-9755
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301104338207X00000X, 174400000X
WI50382-20207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP01299530OtherRAILROAD MEDICARE
MI1184653081Medicaid
TXF26705Medicare UPIN
MI1184653081Medicaid