Provider Demographics
NPI:1760413124
Name:DUNITZ, JORDAN MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:MATTHEW
Last Name:DUNITZ
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:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE, MMC 276
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-624-0999
Mailing Address - Fax:612-625-2174
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:516 DELAWARE STREET SE, PWB SECOND FLOOR, CLINIC 2A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36079207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA01507566Medicaid
MN980363700Medicaid
MN48-00006OtherMEDICA PRIMARY
MN48-29941OtherMEDICA CHOICE
MN103720OtherUCARE
MN30T39DUOtherBCBS
WI31957900Medicaid
MNHP13198OtherHEALTHPARTNERS
ND10387Medicaid
MI208595801Medicaid
MN1012169OtherPREFERRED ONE
MN768090OtherARAZ
SD7777470Medicaid
IA01507566Medicaid
WI31957900Medicaid
MI208595801Medicaid