NPIMap

Organization Active NPI

Jackson OB/GYN

  • Specialist
  • Jackson, MI
National Provider Identifier
1083679971
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
MM012522 Issued in MI
Legal business name
JACKSON OB/GYN
Practice address
300 W Washington Ave
Ste 60
Jackson, MI 49201-2180
Phone
(517) 787-0334
Fax
(517) 787-2114
NPI assigned
Apr 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Michael McDonnell, D.O.
Title
Owner
Phone
(517) 787-0334

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X MM012522 MI Primary

Addresses

Primary practice location

300 W Washington Ave
Ste 60
Jackson, MI 49201-2180

Mailing address

300 W Washington Ave
Ste 60
Jackson, MI 49201-2180
Phone (517) 787-0334

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083679971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W WASHINGTON AVE",
            "address_2": "STE 60",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012180",
            "telephone_number": "517-787-0334",
            "fax_number": "517-787-2114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W WASHINGTON AVE",
            "address_2": "STE 60",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012180",
            "telephone_number": "517-787-0334",
            "fax_number": "517-787-2114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON OB/GYN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCDONNELL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "517-787-0334",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MI",
            "license": "MM012522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.