Provider Demographics
NPI:1770568057
Name:JARDON, FREDERICK LUDWIG (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:LUDWIG
Last Name:JARDON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:22250 PROVIDENCE DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4825
Mailing Address - Country:US
Mailing Address - Phone:248-569-4366
Mailing Address - Fax:248-569-4614
Practice Address - Street 1:22250 PROVIDENCE DR
Practice Address - Street 2:SUITE 304
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4825
Practice Address - Country:US
Practice Address - Phone:248-569-4366
Practice Address - Fax:248-569-4614
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2008-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301028741207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0197220001Medicare NSC