| Doctor Name: | CHERYL BELLANCA JACK |
| NPI Number: | 1750327904 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 4301062157 |
| Business Practice Address: | 812 E Jolly Rd Ste G12 Lansing, MI - 489106818 |
| Business Phone Number: | 5173468283 |
| Business Fax Number: | 5173468291 |
| Mailing Address: | 812 E Jolly Rd, Ste 210 LANSING |
| State: | MI |
| Postal Code: | 489106818 |
| Phone Number: | 5173468410 |
| Fax Number: | 5173468291 |
| NPI Enumeration Date: | 06/22/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 4301062157 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |