Organization
IAN T. JACKSON, M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IAN THOMAS JACKSON M.D. (PHYSICANDIRECTOR)
(248) 465-5300
Entity
Organization
Contact information
Practice address
26850 PROVIDENCE PKWY, STE 205, NOVI, MI 48374-1213
(248) 465-5300
(248) 465-5301
Mailing address
26850 PROVIDENCE PKWY, STE 205, NOVI, MI 48374-1213
(248) 465-5300
(248) 465-5301
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
02/07/2007
Last updated
03/22/2010
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