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Individual

DR. MICHAEL JACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.P.M.

Contact information

Practice address
1930 STATE ROUTE 59, KENT, OH 44240-4112
(330) 673-3505
(330) 673-4888
Mailing address
1930 STATE ROUTE 59, KENT, OH 44240-4112
(330) 596-6000
(330) 596-7752

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
36.003804
OH

Other

Enumeration date
11/18/2014
Last updated
08/20/2020
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