Provider Demographics
NPI:1245244292
Name:JACKISH, JAMIE GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:GEORGE
Last Name:JACKISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2405 LANCASHIRE DR
Mailing Address - Street 2:APT 1A
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1337
Mailing Address - Country:US
Mailing Address - Phone:734-277-5470
Mailing Address - Fax:
Practice Address - Street 1:2405 LANCASHIRE DR
Practice Address - Street 2:APT 1A
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-1337
Practice Address - Country:US
Practice Address - Phone:734-277-5470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301082166207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine