Provider Demographics
NPI:1225349350
Name:JORDAN, SUMANAS WANANT (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMANAS
Middle Name:WANANT
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:675 N SAINT CLAIR ST STE 19-250
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5964
Mailing Address - Country:US
Mailing Address - Phone:312-695-6022
Mailing Address - Fax:312-695-5672
Practice Address - Street 1:675 N SAINT CLAIR ST STE 19-250
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5964
Practice Address - Country:US
Practice Address - Phone:312-695-6022
Practice Address - Fax:312-695-5672
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036140399208200000X
OH35131052208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery