Provider Demographics
NPI:1649221474
Name:FINK, JORDAN N (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:N
Last Name:FINK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:ALLERGY AND IMMUNOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-6840
Mailing Address - Fax:414-266-6437
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:ALLERGY AND IMMUNOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-6840
Practice Address - Fax:414-266-6437
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13637207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30143600Medicaid
WI1649221474Medicaid
002000116OtherHUMANA
WI30143600Medicaid
WI1649221474Medicaid