Organization
LEJA JACKSON INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORETTA M LEJA M D (OWNER)
(231) 597-8192
Entity
Organization
Contact information
Practice address
920 S HURON ST, CHEBOYGAN, MI 49721-2267
(231) 597-8192
(231) 597-8463
Mailing address
920 S HURON ST, CHEBOYGAN, MI 49721-2267
(231) 597-8192
(231) 597-8463
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301042693
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4559907
—
MI
Enumeration date
11/09/2006
Last updated
05/06/2013
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