Organization
PEDIATRIC CENTER OF JACKSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SOUHA S HAKIM M.D. (OWNER)
(517) 783-1779
Entity
Organization
Contact information
Practice address
1418 E MICHIGAN AVE, JACKSON, MI 49202-3518
(517) 783-1779
(517) 783-1899
Mailing address
1418 E MICHIGAN AVE, JACKSON, MI 49202-3518
(517) 783-1779
(517) 783-1899
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
SS068721
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104499710
—
MI
Enumeration date
10/21/2008
Last updated
10/21/2008
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