MEDICARE: JACKSON URGENT CARE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician
2	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1528643723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON URGENT CARE PLLC

Provider Business Mailing Address
First Line	:	1407 E MICHIGAN AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202-3517
Country	:	US
Telephone Number	:	517-888-6348
Fax Number	:

Provider Business Practice Location Address
First Line	:	1407 E MICHIGAN AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202-3517
Country	:	US
Telephone Number	:	313-377-5758
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	DR. IBRAHIM H DABAJA
Credential	:	PA-C, PH.D.
Telephone Number	:	517-888-6348

Provider Enumeration Date	:	03/10/2021
Last Update Date	:	12/19/2022

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