Provider Demographics
NPI:1942294699
Name:JOURDAN, MICHAEL EHRHARDT (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EHRHARDT
Last Name:JOURDAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PODIATRY ASSOCIATES OF WAUSAU, S.C.
Mailing Address - Street 2:1445 MERRILL AVE
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401
Mailing Address - Country:US
Mailing Address - Phone:715-675-2321
Mailing Address - Fax:715-675-6530
Practice Address - Street 1:PODIATRY ASSOCIATES OF WAUSAU, S.C.
Practice Address - Street 2:1445 MERRILL AVE
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401
Practice Address - Country:US
Practice Address - Phone:715-675-2321
Practice Address - Fax:715-675-6530
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI390213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT62356Medicare UPIN
WI0001Medicare PIN