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General NPI Number Information
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NPI Number | 1346731296
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Entity Type | Individual
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Provider Name | JOURDAN BRADSHAW GARD DO
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Gender | Female
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Dates
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Enumeration Date | 05/27/2018
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 11012 E 13 MILE RD STE 112
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City | WARREN
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State | MI
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Zip | 48093-2546
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Country | US
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Telephone | 586-573-6880
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Fax |
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Provider Business Mailing Address
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Address Line | 2399 ELLWOOD AVE
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City | BERKLEY
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State | MI
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Zip | 48072-1048
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Country | US
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Telephone | 325-665-8380
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | 5101027918
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 5101023987
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License Number State | MI
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