Provider Demographics
NPI:1750417788
Name:JORDAN, MIGUEL ANGEL (MD)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANGEL
Last Name:JORDAN
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 1:1900 CHAPEL DR
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-1296
Mailing Address - Country:US
Mailing Address - Phone:419-425-3211
Mailing Address - Fax:419-425-4440
Practice Address - Street 1:1900 CHAPEL DR
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1296
Practice Address - Country:US
Practice Address - Phone:419-425-3211
Practice Address - Fax:419-425-4440
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-5785-J207V00000X
IA36853207V00000X
WYTL783207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0792870Medicaid
OH0671542Medicare PIN
OH0792870Medicaid