Provider Demographics
NPI:1538133863
Name:GORMLEY, JOHN MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:GORMLEY
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:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-272-5100
Mailing Address - Fax:502-272-5114
Practice Address - Street 1:3900 KRESGE WAY
Practice Address - Street 2:SUITE 51-A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4660
Practice Address - Country:US
Practice Address - Phone:502-891-8981
Practice Address - Fax:502-891-4548
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35530208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2438719000OtherPASSPORT ADVANTAGE
KY4881531OtherCIGNA-NRP
KY009597OtherSIHO-NRP
KY400040047OtherMEDICARE PTAN -- NRP
KY50031805OtherPASSPORT HEALTH -NRP
IN200253020Medicaid
INM400053460OtherMEDICARE PTAN- NORTON REHAB. PHYSICIANS
KY000000210852OtherANTHEM PROVIDER #
KY000000694535OtherANTHEM-NRP
KY000057080ZOtherHUMANA-NRP
KY64002199Medicaid
KY1152901OtherPASSPORT
KY400040047OtherMEDICARE PTAN -- NRP
KY50031805OtherPASSPORT HEALTH -NRP