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Individual

DR. IAN ANDREW JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
5515 CLEVELAND AVE, STEVENSVILLE, MI 49127-9670
(269) 429-9644
(269) 429-4002
Mailing address
5515 CLEVELAND AVE, STEVENSVILLE, MI 49127-9670
(269) 429-9644
(269) 429-4002

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301108841
MI
207Q00000X
Family Medicine Physician
47055
KY
207Q00000X
Family Medicine Physician
51389
TN
207Q00000X
Family Medicine Physician
P1331
TX

Other

Enumeration date
05/28/2010
Last updated
12/04/2015
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