Provider Demographics
NPI:1285627174
Name:GEROMETTA, JOHN SEWELL (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SEWELL
Last Name:GEROMETTA
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 1:113 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-3301
Mailing Address - Country:US
Mailing Address - Phone:219-879-2208
Mailing Address - Fax:219-873-3131
Practice Address - Street 1:301 W HOMER ST
Practice Address - Street 2:ST ANTHONY MEMORIAL HOSPITAL
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-4358
Practice Address - Country:US
Practice Address - Phone:219-861-8669
Practice Address - Fax:219-877-1081
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040073A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2017120002OtherCIGNA
IN82425OtherBC/BS
IN5260529OtherCCN
IN5260529OtherCCN
IN2017120002OtherCIGNA
B22945Medicare UPIN