Healthcare Provider Details

I. General information

NPI: 1932468881
Provider Name (Legal Business Name): JABIR KAMAL AKHTAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12140 NEW YORK RANCH RD
JACKSON CA
95642-9407
US

IV. Provider business mailing address

147 N ALMONT AVE
IMLAY CITY MI
48444-1002
US

V. Phone/Fax

Practice location:
  • Phone: 209-257-2400
  • Fax: 209-257-2403
Mailing address:
  • Phone: 810-721-7640
  • Fax: 810-721-7465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301099883
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: