Healthcare Provider Details

I. General information

NPI: 1497744932
Provider Name (Legal Business Name): WILLIAM LUKE JORDAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12900 W.9 MILE ROAD
OAK PARK MI
48237
US

IV. Provider business mailing address

P.O. BOX 353
SOUTHFIELD MI
48037
US

V. Phone/Fax

Practice location:
  • Phone: 248-547-9292
  • Fax: 248-547-2985
Mailing address:
  • Phone: 248-547-9292
  • Fax: 248-547-2985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301048252
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: