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General NPI Number Information
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NPI Number | 1720437551
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Entity Type | Individual
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Provider Name | JORDAN ELIZABETH KUDLA P.A.
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Gender | Female
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 10/22/2019
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Provider Practice Location Address
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Address Line | 11100 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44106-1716
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Country | US
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Telephone | 216-844-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1215 W 10TH ST APT 602
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City | CLEVELAND
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State | OH
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Zip | 44113-1291
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Country | US
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Telephone | 260-415-9955
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.004714RX
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License Number State | OH
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