Individual
KENNETH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
27901 WOODWARD AVE, SUITE 300, BERKLEY, MI 48072-0919
(248) 837-2443
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
(947) 522-0307
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601001747
MI
Other
Enumeration date
03/29/2007
Last updated
01/25/2021
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