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NPI Code Detail

MEDICARE: JORDAN MOTTET

MEDICARE: JORDAN MOTTET
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
1363AM0700XMedical Physician Assistant385005865IL
2363A00000XPhysician Assistant

General Provider Information

NPI Number : 1699202630
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN MOTTET
Provider Business Mailing Address
First Line : 676 N SAINT CLAIR ST STE 2030
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2830
Country : US
Telephone Number : 312-926-6831
Fax Number : 312-926-2200
Provider Business Practice Location Address
First Line : 676 N SAINT CLAIR ST STE 2030
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2830
Country : US
Telephone Number : 312-926-6831
Fax Number : 312-926-2200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2017
Last Update Date : 05/22/2020

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Directions to “ JORDAN MOTTET ” Practice Location

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