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Organization
WESTERN WAYNE FAMILY PHYSICIANS, PLC
Active
Organization
WESTERN WAYNE FAMILY PHYSICIANS, PLC
Active
Other names
Western Wayne Physicians, PLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT J JACKSON M.D. (OWNER / SECRETARY)
(313) 386-5500
Entity
Organization
Contact information
Practice address
7445 ALLEN RD, SUITE 250, ALLEN PARK, MI 48101-1963
(313) 386-5500
(313) 386-3444
Mailing address
7445 ALLEN RD, SUITE 250, ALLEN PARK, MI 48101-1963
(313) 386-5500
(313) 386-3444
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3506382
—
MI
05
—
4172611
—
MI
05
—
4172620
—
MI
05
—
4281910
—
MI
05
—
4545053
—
MI
05
—
4545062
—
MI
05
—
4572954
—
MI
01
—
CC4542
RAILROAD MEDICARE
MI
01
—
CD8151
RAILROAD MEDICARE
MI
01
—
CG3535
RAILROAD MEDICARE
MI
Enumeration date
09/13/2007
Last updated
03/18/2008
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