| NPI | 1740439025 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK A JACKSON Physician/Owner 231-935-0913 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MI 4301051555) |
| Enumeration Date | 2008-09-11 |
| Last Update Date | 2008-12-18 |