Individual
JORDAN M EDELEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
908 DUPONT RD, LOUISVILLE, KY 40207-4602
(502) 749-7909
(502) 749-9397
Mailing address
100 E LIBERTY ST, SUITE 800, LOUISVILLE, KY 40202-1434
(502) 749-7909
(502) 749-9397
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2072
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100375380
—
KY
Enumeration date
11/12/2015
Last updated
03/20/2018
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