Geroski, Jordan
Geroski, Jordan is an individual health care provider with primary practice located at 611 E Douglas Rd Ste 137 , Mishawaka IN 46545-1464. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Sports Medicine is her primary health care specialty. Geroski, Jordan can be contacted via phone (574) 335-6214.Contact Information
Primary practice address
611 E Douglas Rd Ste 137
Mishawaka IN 46545-1464
Phone: (574) 335-6214
Fax:
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 02006037A | Indiana |
Allopathic & Osteopathic Physicians / Sports Medicine | 207QS0010X | 02006037A | Indiana |
Profile Details
NPI number | 1265962633 |
---|---|
LBN Legal business name | Geroski, Jordan |
Credentials | Doctor of Osteopathy (DO) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Jun 18th, 2017 |
Last updated | Jun 25th, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1265962633 | NPPES |
Indiana | Other | 11019303A | STATE LICENSE |
Indiana | MEDICAID | 300004615 | STATE LICENSE |
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