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General NPI Number Information
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NPI Number | 1013066380
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Entity Type | Organization
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Legal Business Name | JORDAN & THOMAS PLLC
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 01/25/2019
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Provider Practice Location Address
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Address Line | 5575 CONNER ST
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City | DETROIT
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State | MI
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Zip | 48213-6400
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Country | US
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Telephone | 313-579-4555
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 15407
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City | DETROIT
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State | MI
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Zip | 48215-0407
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM LUKE JORDAN
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Credential | M.D.
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Telephone | 313-579-4555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | BT042967
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | SF046607
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | WJ048252
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License Number State | MI
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