Provider Demographics
NPI:1447211941
Name:JORDAN, KAREN L T (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L T
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-8126
Mailing Address - Country:US
Mailing Address - Phone:219-769-7060
Mailing Address - Fax:773-304-1490
Practice Address - Street 1:311 E 89TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8126
Practice Address - Country:US
Practice Address - Phone:219-769-7060
Practice Address - Fax:773-304-1490
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-01
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057516207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200465340Medicaid
IN499500GGGMedicare PIN
IN200465340Medicaid