| Hershel C Jackson Md Pc | |
|
23077 Greenfield Rd #450 Southfield MI 48075 | |
| (248) 599-8810 | |
| Not Available |
| Full Name | Hershel C Jackson Md Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 23077 Greenfield Rd, Southfield, Michigan |
| Authorized Official Name and Position | Hershel Clark Jackson (MEDICAL DOCTOR) |
| Authorized Official Contact | 2485598810 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hershel C Jackson Md Pc 23077 Greenfield Rd #450 Southfield MI 48075 Ph: (248) 599-8810 | Hershel C Jackson Md Pc 23077 Greenfield Rd #450 Southfield MI 48075 Ph: (248) 599-8810 |
| NPI Number | 1659536076 |
|---|---|
| Provider Enumeration Date | 07/24/2008 |
| Last Update Date | 10/01/2014 |
| Medicare PECOS PAC ID | 7214068121 |
|---|---|
| Medicare Enrollment ID | O20100621000769 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659536076 | NPI | - | NPPES |
| BC BS | Other | 0635321 | |
| 287072310 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | AJ043930 (Michigan) | Primary |
| Provider Name | Hershel C Jackson |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1023153178 PECOS PAC ID: 3375674294 Enrollment ID: I20100621000815 |
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