| NPI | 1659536076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HERSHEL CLARK JACKSON Medical Doctor 248-559-8810 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI AJ043930) |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2014-10-01 |