Basic Information
| Provider Information | |||||||||
| NPI: | 1033441019 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | JORDAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3301 W FOREST HOME AVE | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532152843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143255244 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6901 W EDGERTON AVE | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532204420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143255244 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2010 | ||||||||
| LastUpdateDate: | 11/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 263118 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 263118 | NY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 57.014152 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 63012 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.