Provider Demographics
NPI:1851519771
Name:POMPONI, JOHN JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:POMPONI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W 89TH AVE STE W5
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7050
Mailing Address - Country:US
Mailing Address - Phone:219-662-2279
Mailing Address - Fax:855-742-9438
Practice Address - Street 1:333 W 89TH AVE STE W5
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7050
Practice Address - Country:US
Practice Address - Phone:219-662-2279
Practice Address - Fax:855-742-9438
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016950282N00000X
IN02003900A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201031840Medicaid