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NPI Code Detail

MEDICARE: BRIA MAXINE JORDAN

MEDICARE: BRIA MAXINE JORDAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician036.17937IL

General Provider Information

NPI Number : 1083294771
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIA MAXINE JORDAN
Provider Business Mailing Address
First Line : 7037 S STONY ISLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60649-1905
Country : US
Telephone Number : 312-355-5590
Fax Number : 312-355-5571
Provider Business Practice Location Address
First Line : 7037 S STONY ISLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60649-1905
Country : US
Telephone Number : 312-996-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2021
Last Update Date : 10/01/2024

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Directions to “ BRIA MAXINE JORDAN ” Practice Location

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