MEDICARE: DR. JORDAN GIL MARMET M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	45577	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	132358	OTHER	MN	UCARE
2	501T9MA	OTHER	MN	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1203084	OTHER	MN	MEDICA
5	CP9041040409	OTHER	MN	PREFERREDONE

General Provider Information

NPI Number	:	1447224084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN GIL MARMET M.D.

Provider Business Mailing Address
First Line	:	720 WASHINGTON AVE SE
Second Line	:	UNIVERSITY OF MINNESOTA PHYSICIANS
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414
Country	:	US
Telephone Number	:	612-884-0649
Fax Number	:	612-676-8992

Provider Business Practice Location Address
First Line	:	500 HARVARD ST SE
Second Line	:	UNIVERSITY OF MINNESOTA MEDICAL CENTER, FAIRVIEW
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55455-0363
Country	:	US
Telephone Number	:	612-273-3000
Fax Number	:	612-273-4370

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	02/20/2013

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