Healthcare Provider Details

I. General information

NPI: 1447744057
Provider Name (Legal Business Name): JARED MICHAEL MEYETTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CAMPUS DR
HANCOCK MI
49930-1452
US

IV. Provider business mailing address

506 CAMPUS DR
HANCOCK MI
49930-1569
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-1700
  • Fax: 906-372-3230
Mailing address:
  • Phone: 906-483-1700
  • Fax: 906-372-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301114509
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301503950
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: