Provider Demographics
NPI:1437161932
Name:EICHORST, JOHN PAUL (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:EICHORST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50795 INDIANA STATE ROUTE 933
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-2050
Mailing Address - Country:US
Mailing Address - Phone:574-272-7500
Mailing Address - Fax:574-272-2291
Practice Address - Street 1:50795 INDIANA STATE ROUTE 933
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637-2050
Practice Address - Country:US
Practice Address - Phone:574-272-7500
Practice Address - Fax:574-272-2291
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057436A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100221110AMedicaid
IN144310AMedicare PIN
INE34857Medicare UPIN