Provider Demographics
NPI:1588288278
Name:CORRELL, JORDAN MATTHEW (DO)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:MATTHEW
Last Name:CORRELL
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:32255 NORTHWESTERN HWY STE 130A
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1566
Mailing Address - Country:US
Mailing Address - Phone:248-723-5880
Mailing Address - Fax:248-723-5889
Practice Address - Street 1:32255 NORTHWESTERN HWY STE 130A
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1566
Practice Address - Country:US
Practice Address - Phone:248-723-5880
Practice Address - Fax:248-723-5889
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2023-06-20
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Provider Licenses
StateLicense IDTaxonomies
MI5101027450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine