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General NPI Number Information
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NPI Number | 1881628253
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Entity Type | Individual
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Provider Name | JOHN K EVERETT D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | 6135 CRESSY ST
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City | INDIAN RIVER
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State | MI
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Zip | 49749
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Country | US
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Telephone | 231-238-8908
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Fax | 231-238-4419
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Provider Business Mailing Address
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Address Line | 1035 W WASHINGTON AVE
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City | ALPENA
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State | MI
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Zip | 49707-2929
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Country | US
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Telephone | 989-736-9815
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101010086
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License Number State | MI
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