Individual
JORDAN MAIVELETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
211 E ONTARIO ST, SUITE 200, CHICAGO, IL 60611-3468
(312) 926-9512
(312) 926-6274
Mailing address
25 E DELAWARE PL, APT 306, CHICAGO, IL 60611-1828
(803) 292-4936
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
125-068371
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/30/2016
Last updated
01/19/2017
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