Provider Demographics
NPI:1558362855
Name:SCOVEL, JO NEL (DO)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:NEL
Last Name:SCOVEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HOBART ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2331
Mailing Address - Country:US
Mailing Address - Phone:231-775-6076
Mailing Address - Fax:231-775-0027
Practice Address - Street 1:400 HOBART ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2331
Practice Address - Country:US
Practice Address - Phone:231-876-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJS011662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080072897OtherRAILROAD MEDICARE
MI0858300095OtherBCBS INDIVIDUAL
MI104374OtherPREFERRED CHOICE ID
MI0858300095OtherBLUE CROSS/SHIELD INDIVID
MI0H36303OtherBLUE CROSS/SHIELD GROUP
MI3167279Medicaid
MI4395949-11Medicaid
MI4395949Medicaid
MI104374OtherPREFERRED CHOICE ID
MI3167279Medicaid