Healthcare Provider Details

I. General information

NPI: 1154942266
Provider Name (Legal Business Name): JORDAN FRANCIS DEMCHUK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JORDAN DEMCHUK MD

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

IV. Provider business mailing address

1200 E MICHIGAN AVE STE 245
LANSING MI
48912-1897
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5710
  • Fax:
Mailing address:
  • Phone: 517-364-5710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4351046347
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101286442
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number4301509394
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: