Healthcare Provider Details

I. General information

NPI: 1376274258
Provider Name (Legal Business Name): JORDAN JABARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 BUSINESS PARK DR
TRAVERSE CITY MI
49686-8683
US

IV. Provider business mailing address

929 BUSINESS PARK DR
TRAVERSE CITY MI
49686-8683
US

V. Phone/Fax

Practice location:
  • Phone: 231-947-6246
  • Fax:
Mailing address:
  • Phone: 231-947-6246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301517655
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: