Jackson Ob/Gyn
Specialist in Jackson, MI. Organization (NPI-2).
NPI number1083679971
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1083679971
- Entity type
- Organization (NPI-2)
- Legal business name
- Jackson Ob/Gyn
- Organization subpart
- No
- Enumeration date
- Apr 20, 2006
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | MM012522 | MI | Yes |
Practice location
300 W Washington AveSte 60
Jackson, MI 49201-2180
Phone 517-787-0334 · Fax 517-787-2114
Mailing address
300 W Washington AveSte 60
Jackson, MI 49201-2180
Phone 517-787-0334 · Fax 517-787-2114
Authorized official
Michael McDonnell
Owner
5177870334
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