Healthcare Provider Details

I. General information

NPI: 1336725688
Provider Name (Legal Business Name): IEP URGENT CARE - JACKSON PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 E MICHIGAN AVE
JACKSON MI
49201-1625
US

IV. Provider business mailing address

37000 GRAND RIVER AVE STE 310
FARMINGTON HILLS MI
48335-2868
US

V. Phone/Fax

Practice location:
  • Phone: 517-539-3018
  • Fax:
Mailing address:
  • Phone: 248-536-2127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN C KULISH
Title or Position: DIRECTOR OF AMBULATORY SERVICES
Credential: MD
Phone: 248-892-0715