Provider Demographics
NPI:1306071857
Name:POVICH, JORDAN M (DO)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:M
Last Name:POVICH
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Gender:M
Credentials:DO
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Mailing Address - Street 1:3409 LUDINGTON ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-4212
Mailing Address - Country:US
Mailing Address - Phone:906-786-8343
Mailing Address - Fax:906-786-6939
Practice Address - Street 1:3409 LUDINGTON ST
Practice Address - Street 2:SUITE 104
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-4212
Practice Address - Country:US
Practice Address - Phone:906-786-8343
Practice Address - Fax:906-786-6939
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2016-08-11
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Provider Licenses
StateLicense IDTaxonomies
MI51010108099207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine