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General NPI Number Information
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NPI Number | 1508846320
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Entity Type | Individual
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Provider Name | LOIS MICHELLE BUTLER-JACKSON MD, CWS
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Gender | Female
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 03/16/2010
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Provider Practice Location Address
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Address Line | 37400 GARFIELD RD SUITE 110
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City | CLINTON TWP
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State | MI
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Zip | 48036-3648
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Country | US
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Telephone | 586-286-6389
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Fax | 586-226-0403
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Provider Business Mailing Address
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Address Line | 37400 GARFIELD RD SUITE 110
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City | CLINTON TWP
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State | MI
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Zip | 48036-3648
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Country | US
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Telephone | 586-286-6389
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Fax | 586-226-0403
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301051182
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License Number State | MI
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