Individual
KENNETH N JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
520 WEST MADISON STREET, MADISON STREET CLINIC PC, PONTIAC, IL 61764
(815) 844-6106
(815) 842-2526
Mailing address
520 WEST MADISON, PONTIAC, IL 61764
(815) 844-6106
(815) 842-2526
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
003036052185
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036052185
—
IL
Enumeration date
09/11/2006
Last updated
07/08/2007
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