KENNETH N JORDAN DO NPI 1710081708

NPI Information

  • NPI: 1710081708
  • Provider Name: KENNETH N JORDAN, DO
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Individual
  • Address: 520 WEST MADISON STREET
    MADISON STREET CLINIC PC
    PONTIAC, IL
    ZIP 61764
  • Phone: (815) 844-6106

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NPI Details

Kenneth N Jordan, DO is a family medicine in Pontiac, IL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. Kenneth N Jordan, DO NPI is 1710081708. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

520 WEST MADISON STREET
MADISON STREET CLINIC PC
PONTIAC, IL
ZIP 61764
Phone: (815) 844-6106
Fax: (815) 842-2526

The enumeration date for this NPI number is 9/11/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine003036052185ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1E14944MEDICARE UPIN
2219130MEDICARE ID-TYPE UNSPECIFIEDILLINOIS
3036052185MEDICAIDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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