Provider Demographics
NPI:1760610885
Name:KNEPPER, JORDAN (MD)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:KNEPPER
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-267-2460
Mailing Address - Fax:517-884-8602
Practice Address - Street 1:4660 S HAGADORN RD STE 600
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5383
Practice Address - Country:US
Practice Address - Phone:517-267-2460
Practice Address - Fax:517-884-8602
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2022-07-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010941872086S0129X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery