# IAN T. JACKSON, M.D.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649310632
- **Authorized official:** DR. IAN THOMAS JACKSON M.D. (PHYSICANDIRECTOR)
- **Authorized official phone:** (248) 465-5300

## Contact information

- **Practice address:** 26850 PROVIDENCE PKWY, STE 205, NOVI, MI 48374-1213
- **Practice address phone:** (248) 465-5300
- **Practice address fax:** (248) 465-5301
- **Mailing address:** 26850 PROVIDENCE PKWY, STE 205, NOVI, MI 48374-1213
- **Mailing address phone:** (248) 465-5300
- **Mailing address fax:** (248) 465-5301

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 02/07/2007
- **Last updated:** 03/22/2010