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NPI Code Detail

MEDICARE: MICHAEL ANDREW JORDAN M.D.

MEDICARE: MICHAEL ANDREW JORDAN 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
1207WX0109XNeuro-ophthalmology Physician65545MN
2390200000XStudent in an Organized Health Care Education/Training Program
3207W00000XOphthalmology Physician65545MN

General Provider Information

NPI Number : 1861889776
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL ANDREW JORDAN M.D.
Provider Business Mailing Address
First Line : 825 NICOLLET MALL STE 2000
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55402-2708
Country : US
Telephone Number : 612-338-4861
Fax Number :
Provider Business Practice Location Address
First Line : 825 NICOLLET MALL STE 2000
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55402-2708
Country : US
Telephone Number : 612-338-4861
Fax Number : 612-333-8306
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2015
Last Update Date : 07/01/2022

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