Individual
JORDAN HATCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2930 W CLEVELAND ROAD EXT, SOUTH BEND, IN 46628-6090
(574) 335-8450
(574) 335-0780
Mailing address
5215 HOLY CROSS PKWY, PROVIDER SERVICES-ENROLLMENT, MISHAWAKA, IN 46545-1469
(574) 335-8707
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01092640A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300050952
—
IN
Enumeration date
03/27/2021
Last updated
07/23/2024
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