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Contact Information

MARK A JACKSON MD PLC
1000 PAVILLIONS CIR
TRAVERSE CITY, MI49684-3198
 Phone: 231-935-0913
 Fax: 231-935-0984
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Geriatric Medicine

207QG0300X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for MARK A JACKSON MD PLC · (Female)

NPI Number 1740439025
Status Active
Credentials
Entity Individual
Enumeration date 09/11/2008
Last updated 12/18/2008 - About 17 years ago
Sole proprietor 1 Not specified
Identifiers
  • MI License # 4301051555
  • MI Medicaid 1073585238
  • MI Other 0B81350 BCBS GROUP ID#
  • MI Other 080B813500 BCBS ID#
  • MI Other 0802802421 BCBS PIN#
  • MI Other 1740439025 GROUP NPI
  • MI Other 1073585238 IND NPI
  • MI Other 0MI1114 MEDICARE GROUP
  • MI Other MI1114001 MEDICARE IND PTAN
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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