MEDICARE: JORDAN PETER MAKELA M.D.

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
1	2086S0127X	Trauma Surgery Physician	71256	WI
2	208600000X	Surgery Physician	71256-20	WI
3	208600000X	Surgery Physician	70057	CT
4	2086S0102X	Surgical Critical Care Physician	171108	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245632389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN PETER MAKELA M.D.

Provider Business Mailing Address
First Line	:	700 S PARK ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53715-1830
Country	:	US
Telephone Number	:	608-251-6100
Fax Number	:	608-260-2976

Provider Business Practice Location Address
First Line	:	700 S PARK ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53715-1830
Country	:	US
Telephone Number	:	608-251-6100
Fax Number	:	608-260-2976

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2014
Last Update Date	:	04/08/2026

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