Provider Demographics
NPI:1104829449
Name:GARRETT, JOHN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:GARRETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 CARPENTER AVENUE
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-4728
Mailing Address - Country:US
Mailing Address - Phone:906-774-1404
Mailing Address - Fax:906-774-8132
Practice Address - Street 1:1301 CARPENTER AVENUE
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-4728
Practice Address - Country:US
Practice Address - Phone:906-774-1404
Practice Address - Fax:906-774-8132
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28873-20174400000X
MI040476207W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1366282Medicaid
MI1802210720OtherBLUE CROSS BLUE SHIELD
WI000240155Medicare PIN
MIP41670001Medicare PIN
MI0222850Medicare ID - Type Unspecified
WI180045785Medicare PIN
MIB45514Medicare UPIN
MI1366282Medicaid