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General NPI Number Information
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NPI Number | 1487235545
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Entity Type | Individual
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Provider Name | JORDAN LEEANN YOUNG DPM
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Gender | Female
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 3768 PACKARD ST
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City | ANN ARBOR
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State | MI
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Zip | 48108-2090
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Country | US
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Telephone | 734-975-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 8031 PARDEE RD
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City | TAYLOR
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State | MI
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Zip | 48180-2323
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Country | US
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Telephone | 517-582-3323
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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 | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 5901400527
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License Number State | MI
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