MEDICARE: JORDAN L ENGELMAN PA-C

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	363AM0700X	Medical Physician Assistant	15-01807	KS
2	363AM0700X	Medical Physician Assistant	2347	OK
3	363AM0700X	Medical Physician Assistant	2015018862	MO

General Provider Information

NPI Number	:	1578988739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN L ENGELMAN PA-C

Provider Business Mailing Address
First Line	:	401 N MICHIGAN AVE
Second Line	:	SUITE 1200
City	:	CHICAGO
State	:	IL
Zip	:	60611-4255
Country	:	US
Telephone Number	:	312-635-0973
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 N MICHIGAN AVE
Second Line	:	SUITE 1200
City	:	CHICAGO
State	:	IL
Zip	:	60611-4255
Country	:	US
Telephone Number	:	312-635-0973
Fax Number	:

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

Provider Enumeration Date	:	02/25/2014
Last Update Date	:	02/10/2022

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