Individual
MR. JORDAN MICAH FERNANDEZ POLISTICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1102 MONROE ST SW, HUNTSVILLE, AL 35801-5029
(256) 469-7200
(256) 469-7201
Mailing address
901 MCCLINTOCK DR STE 202, BURR RIDGE, IL 60527-0872
(630) 655-6748
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
46768
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/08/2017
Last updated
09/29/2023
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