Provider Demographics
NPI:1336118363
Name:JORDAN, MATTHIAS JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHIAS
Middle Name:JOSEPH
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7266 COUNTY ROAD 37 NE
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-3007
Mailing Address - Country:US
Mailing Address - Phone:763-295-4789
Mailing Address - Fax:763-295-1900
Practice Address - Street 1:114 W 3RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8791
Practice Address - Country:US
Practice Address - Phone:763-295-8826
Practice Address - Fax:763-295-1900
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN25273207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN322877100Medicaid
MND80192Medicare UPIN
MN322877100Medicaid