Provider Demographics
NPI:1689884553
Name:JEWELL, KAY E (MD)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:E
Last Name:JEWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 MARTHAS LN
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-4812
Mailing Address - Country:US
Mailing Address - Phone:715-345-1905
Mailing Address - Fax:
Practice Address - Street 1:23 PARK RIDGE DR UNIT 1
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-4432
Practice Address - Country:US
Practice Address - Phone:715-345-1905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23376207R00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIH63263Medicare UPIN
ORR113405Medicare ID - Type Unspecified