Organization
CENTRAL MICHIGAN UNIVERSITY
Active
Parent organization
1588897896
Organization subpart
Yes
Provider details
NPI number
Legal business name
1588897896
Authorized official
MATTHEW JACKSON (ATHLETIC DIRECTOR)
(989) 774-7657
Entity
Organization
Contact information
Practice address
CMU SPORTS MEDICINE, ROSE 100, MT PLEASANT, MI 48859-0001
(989) 774-2281
(989) 774-1095
Mailing address
CMU SPORTS MEDICINE, ROSE 100, MT PLEASANT, MI 48859-0001
(989) 774-2281
(989) 774-1095
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
5101018472
MI
Other
Enumeration date
05/04/2016
Last updated
05/27/2016
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