Provider Demographics
NPI:1689678955
Name:MIRRO, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:MIRRO
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 1:7895 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6665
Mailing Address - Country:US
Mailing Address - Phone:219-947-1910
Mailing Address - Fax:219-947-3117
Practice Address - Street 1:101 E 87TH AVE STE 420
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7335
Practice Address - Country:US
Practice Address - Phone:219-758-5008
Practice Address - Fax:219-758-5009
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024382A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN110044492OtherRAILROAD MEDICARE
IN100187310AMedicaid
IN000000085025OtherANTHEM BC/BS
IL9115389OtherANTHEM BC/BS
E12219Medicare UPIN
IN496850EMedicare PIN