Individual
DR. JORDAN MAXWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1701 S CREASY LN, LAFAYETTE, IN 47905-4972
(765) 502-4780
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
02007042A
IN
208600000X
Surgery Physician
5101022569
MI
2086S0122X
Plastic and Reconstructive Surgery Physician
5101025758
MI
Other
Enumeration date
06/07/2016
Last updated
08/11/2025
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