| Leja Jackson Inc | |
|
920 S Huron St Cheboygan MI 49721-2267 | |
| (231) 597-8192 | |
| (231) 597-8463 |
| Full Name | Leja Jackson Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 920 S Huron St, Cheboygan, Michigan |
| Authorized Official Name and Position | Loretta M Leja (OWNER) |
| Authorized Official Contact | 2315978192 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Leja Jackson Inc 920 S Huron St Cheboygan MI 49721-2267 Ph: (231) 597-8192 | Leja Jackson Inc 920 S Huron St Cheboygan MI 49721-2267 Ph: (231) 597-8192 |
| NPI Number | 1235209099 |
|---|---|
| Provider Enumeration Date | 11/09/2006 |
| Last Update Date | 05/06/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235209099 | NPI | - | NPPES |
| 4559907 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 4301042693 (Michigan) | Primary |
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