Provider Demographics
NPI:1962563056
Name:SACKSNER, JORDY STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:JORDY
Middle Name:STEVEN
Last Name:SACKSNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:32255 NORTHWESTERN HWY
Mailing Address - Street 2:STE 130
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1505
Mailing Address - Country:US
Mailing Address - Phone:248-865-2575
Mailing Address - Fax:248-865-2590
Practice Address - Street 1:6900 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3405
Practice Address - Country:US
Practice Address - Phone:248-865-2575
Practice Address - Fax:248-865-2590
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2019-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIJS059227208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1962563056Medicaid
G71847Medicare UPIN
MIOF36140Medicare PIN