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Organization
CENTRAL MICHIGAN UNIVERSITY
Active
Organization
CENTRAL MICHIGAN UNIVERSITY
Active
Parent organization
1588897896
Organization subpart
Yes
Provider details
NPI number
Legal business name
1588897896
Authorized official
MATTHEW JACKSON (ATHLETIC DIRECTOR)
(989) 774-7657
Entity
Organization
Contact information
Practice address
CMU SPORTS MEDICINE, ROSE 100, MT PLEASANT, MI 48859-0001
(989) 774-2281
(989) 774-1095
Mailing address
CMU SPORTS MEDICINE, ROSE 100, MT PLEASANT, MI 48859-0001
(989) 774-2281
(989) 774-1095
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
5101018472
MI
Other
Enumeration date
05/04/2016
Last updated
05/27/2016
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