Provider Demographics
NPI:1457353633
Name:OCKENFELS, JOHN PATRICK (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PATRICK
Last Name:OCKENFELS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:560 OSBORN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1961
Mailing Address - Country:US
Mailing Address - Phone:906-632-1800
Mailing Address - Fax:906-632-2199
Practice Address - Street 1:560 OSBORN BLVD
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1961
Practice Address - Country:US
Practice Address - Phone:906-632-1800
Practice Address - Fax:906-632-2199
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJO010103207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF00489Medicare UPIN