Individual
PHILIP JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 HAMLIN DR, INKSTER, MI 48141-2348
(313) 561-5100
(313) 565-0309
Mailing address
26650 EUREKA RD, SUITE C-1, TAYLOR, MI 48180-4835
(734) 941-4991
(734) 941-4919
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301025901
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0994622
HEALTH PLUS MMMI
MI
01
—
1020381
MCLAREN HEALTH PLAN HAN
MI
01
—
1437174638
NPI
MI
01
—
17572
MCARE MMMI
MI
01
—
350D410030
BCN BLUE CHOICE FENTON
MI
05
—
4737508
—
MI
05
—
4859153
—
MI
01
—
700H228520
BCBSM
MI
Enumeration date
07/12/2006
Last updated
10/21/2009
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