Healthcare Provider Details

I. General information

NPI: 1962107458
Provider Name (Legal Business Name): KADEN JORDAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 N CELIA AVE
MUNCIE IN
47303-4609
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 765-747-3141
  • Fax: 765-747-3175
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01096468A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: