Individual
DR. MILES JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 W WASHINGTON AVE STE 300, JACKSON, MI 49201-2160
(517) 205-1305
(313) 876-1305
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 874-4806
(313) 876-1305
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
4301508401
MI
2086S0129X
Vascular Surgery Physician
Primary
4301508401
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/14/2015
Last updated
12/16/2022
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