MEDICARE: JESSICA M PAQUETTE DO

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	207Q00000X	Family Medicine Physician	5101015389	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	JP015389	OTHER	MI	BLUE CROSS BLUE SHIELD BLUE CARE NETWORK LICENSE
4	080A760010	OTHER	MI	BCBS
5	70-0-A7-6020-0	OTHER	MI	BLUE CROSS BLUE SHIELD BLUE CARE NETWORK PIN

General Provider Information

NPI Number	:	1811952781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA M PAQUETTE DO

Provider Business Mailing Address
First Line	:	718 N SAINT JOSEPH ST UNIT K1
Second Line	:
City	:	SUTTONS BAY
State	:	MI
Zip	:	49682-8422
Country	:	US
Telephone Number	:	231-386-0088
Fax Number	:	855-537-4321

Provider Business Practice Location Address
First Line	:	718 N SAINT JOSEPH ST UNIT K1
Second Line	:
City	:	SUTTONS BAY
State	:	MI
Zip	:	49682-8422
Country	:	US
Telephone Number	:	231-386-0088
Fax Number	:	855-537-4321

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	07/15/2024

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Directions to “ JESSICA M PAQUETTE DO” Practice Location

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