Organization
HERSHEL C JACKSON MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HERSHEL CLARK JACKSON MD (MEDICAL DOCTOR)
(248) 559-8810
Entity
Organization
Contact information
Practice address
23077 GREENFIELD RD, #450, SOUTHFIELD, MI 48075
(248) 599-8810
Mailing address
23077 GREENFIELD RD, #450, SOUTHFIELD, MI 48075
(248) 599-8810
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
AJ043930
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
287072310
—
MI
01
—
BC BS
0635321
—
Enumeration date
07/24/2008
Last updated
10/01/2014
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