Healthcare Provider Details

I. General information

NPI: 1972434470
Provider Name (Legal Business Name): MATTHEW BRENNAN JACKSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMED 1632 STONE ST
SAGINAW MI
48602
US

IV. Provider business mailing address

7762 JON SCOTT DR
GRAND LEDGE MI
48837-9279
US

V. Phone/Fax

Practice location:
  • Phone: 989-583-6595
  • Fax:
Mailing address:
  • Phone: 517-214-4383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: