MEDICARE: DR. JOHN MICHAEL GARRETT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	28873-20	WI
2	207W00000X	Ophthalmology Physician	040476	MI
3	174400000X	Specialist	040476	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1802210720	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1104829449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MICHAEL GARRETT M.D.

Provider Business Mailing Address
First Line	:	1301 CARPENTER AVENUE
Second Line	:
City	:	IRON MOUNTAIN
State	:	MI
Zip	:	49801-4728
Country	:	US
Telephone Number	:	906-774-1404
Fax Number	:	906-774-8132

Provider Business Practice Location Address
First Line	:	1301 CARPENTER AVENUE
Second Line	:
City	:	IRON MOUNTAIN
State	:	MI
Zip	:	49801-4728
Country	:	US
Telephone Number	:	906-774-1404
Fax Number	:	906-774-8132

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	01/28/2019

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