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NPI Code Detail

MEDICARE: JORDAN CONNELL PA

MEDICARE: JORDAN CONNELL PA
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1306355599
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN CONNELL PA
Provider Business Mailing Address
First Line : PO BOX 772928
Second Line :
City : DETROIT
State : MI
Zip : 48277-2928
Country : US
Telephone Number : 800-589-6006
Fax Number :
Provider Business Practice Location Address
First Line : 7007 POWERS BLVD
Second Line :
City : PARMA
State : OH
Zip : 44129-5437
Country : US
Telephone Number : 240-686-2300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2017
Last Update Date : 06/10/2026

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Directions to “ JORDAN CONNELL PA” Practice Location

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