Individual
JORDAN THADDEUS MAHIEU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
640 JACKSON ST # MS 11102F, SAINT PAUL, MN 55101-2502
(952) 883-5129
Mailing address
PO BOX 1309, MINNEAPOLIS, MN 55440-1309
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
01/05/2018
Last updated
01/05/2018
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