Healthcare Provider Details

I. General information

NPI: 1558999821
Provider Name (Legal Business Name): JORDAN ARTHUR UEBERROTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 CASCADE RD SE
GRAND RAPIDS MI
49546-3725
US

IV. Provider business mailing address

5030 CASCADE RD SE
GRAND RAPIDS MI
49546-3725
US

V. Phone/Fax

Practice location:
  • Phone: 616-954-2020
  • Fax: 616-949-0408
Mailing address:
  • Phone: 616-954-2020
  • Fax: 616-949-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number4301515739
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: