MEDICARE: JORDAN F FLEISHHACKER 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	208600000X	Surgery Physician	192315-1	NY

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336172048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN F FLEISHHACKER M.D.

Provider Business Mailing Address
First Line	:	1650 COCHRANE CIR
Second Line	:	BLDG 7505, ROOM 163
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4604
Country	:	US
Telephone Number	:	719-524-7355
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 COCHRANE CIR
Second Line	:	BLDG 7505, ROOM 163
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4604
Country	:	US
Telephone Number	:	719-524-7355
Fax Number	:

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	05/13/2014

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