Basic Information
| Provider Information | |||||||||
| NPI: | 1942294699 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOURDAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | EHRHARDT | ||||||||
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| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PODIATRY ASSOCIATES OF WAUSAU, S.C. | ||||||||
| Address2: | 1445 MERRILL AVE | ||||||||
| City: | WAUSAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156752321 | ||||||||
| FaxNumber: | 7156756530 | ||||||||
| Practice Location | |||||||||
| Address1: | PODIATRY ASSOCIATES OF WAUSAU, S.C. | ||||||||
| Address2: | 1445 MERRILL AVE | ||||||||
| City: | WAUSAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156752321 | ||||||||
| FaxNumber: | 7156756530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2005 | ||||||||
| LastUpdateDate: | 02/29/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 390 | WI | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.