Healthcare Provider Details

I. General information

NPI: 1699425918
Provider Name (Legal Business Name): JORDAN SAEED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N 92ND ST
MILWAUKEE WI
53226-1202
US

IV. Provider business mailing address

1830 E SITKA LN
MOUNT PROSPECT IL
60056-1716
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-3000
  • Fax:
Mailing address:
  • Phone: 224-616-7741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: