Individual
MICHAEL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10816 WASHINGTON BAY DR, FISHERS, IN 46037-9554
(317) 801-0551
Mailing address
10816 WASHINGTON BAY DR, FISHERS, IN 46037-9554
(317) 801-0551
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
2310019002
IN
Other
Enumeration date
05/27/2022
Last updated
09/25/2025
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