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General NPI Number Information
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NPI Number | 1821433210
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Entity Type | Individual
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Provider Name | JOURDAN CANCIENNE MD
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Gender | Male
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Dates
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Enumeration Date | 04/30/2013
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 963 N 129TH INFANTRY DR
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City | JOLIET
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State | IL
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Zip | 60435-3104
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Country | US
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Telephone | 708-492-5900
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Fax | 708-409-5179
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Provider Business Mailing Address
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Address Line | 963 N 129TH INFANTRY DR
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City | JOLIET
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State | IL
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Zip | 60435-3104
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Country | US
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Telephone | 708-492-5900
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Fax | 708-409-5179
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 01079836A
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License Number State | IN
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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 | 036145036
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 01079836A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 036145036
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License Number State | IL
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