Most Relevant Information
Provider Data
| NPI Number: | 1003323502 |
| Provider Name: | JORDAN THADDEUS MAHIEU PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: |
Most Important Dates
| Enumeration Date: | 01/05/2018 |
| Last Updated: | 01/05/2018 |
Provider Practice Location
640 JACKSON ST # MS 11102F
SAINT PAUL
MN
551012502
Practice Location Phone/Fax
| Phone: | 9528835129 |
| Fax: |
Provider Mailing Location
PO BOX 1309
MINNEAPOLIS
MN
554401309
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |