Individual
JACKSON PHILIP HARVEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 955-1195
Mailing address
9 BROOKE LN, SOUTH BARRINGTON, IL 60010-9360
(630) 338-6082
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/27/2023
Last updated
04/22/2024
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