Individual
MICHELE JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
145 N CHALKVILLE RD, TRUSSVILLE, AL 35173-1330
(205) 661-3737
Mailing address
145 N CHALKVILLE RD, TRUSSVILLE, AL 35173-1330
(205) 661-3737
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
18368
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529916720
—
AL
01
—
631250657
TAX ID
AL
Enumeration date
05/30/2006
Last updated
11/20/2009
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