Organization
JACKSON ORTHOPAEDIC CARE & SURGERY, P.C.
Active
Organization
JACKSON ORTHOPAEDIC CARE & SURGERY, P.C.
Active
Parent organization
JACKSON ORTHOPAEDIC CARE & SURGERY PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
JACKSON ORTHOPAEDIC CARE & SURGERY PC
Authorized official
DR. KHAWAJA HAROUN IKRAM D.O. (PRESIDENT)
(517) 784-1495
Entity
Organization
Contact information
Practice address
200 SUMMIT AVE, SUITE A, JACKSON, MI 49201-2464
(517) 784-1495
(517) 784-1051
Mailing address
3816 MOMENTUM PL, CHICAGO, IL 60689-5338
(517) 784-1495
(517) 784-1051
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
5101010754
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
540C811480
BCBS SUPPLIER PIN
MI
Enumeration date
05/24/2007
Last updated
04/03/2015
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