Individual
TAMEKA PETA-GAY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
15855 19 MILE RD, CLINTON TOWNSHIP, MI 48038-3504
(586) 263-2950
Mailing address
15855 19 MILE RD, CLINTON TOWNSHIP, MI 48038-3504
(586) 263-2950
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
5101018465
MI
Other
Enumeration date
03/02/2010
Last updated
03/02/2010
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