Healthcare Provider Details

I. General information

NPI: 1295430775
Provider Name (Legal Business Name): JORDAN DOUGLAS HAWKINS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 WAUKEGAN RD STE F
GLENVIEW IL
60025-1759
US

IV. Provider business mailing address

2726 RAVINESIDE LN S # 2
HOWELL MI
48843-6542
US

V. Phone/Fax

Practice location:
  • Phone: 847-558-7670
  • Fax: 888-202-3110
Mailing address:
  • Phone: 517-672-6488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016006178
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: