Provider Demographics
NPI:1811952781
Name:PAQUETTE, JESSICA M (DO)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:PAQUETTE
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 1:718 N SAINT JOSEPH ST UNIT K1
Mailing Address - Street 2:
Mailing Address - City:SUTTONS BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49682-8422
Mailing Address - Country:US
Mailing Address - Phone:231-386-0088
Mailing Address - Fax:855-537-4321
Practice Address - Street 1:718 N SAINT JOSEPH ST UNIT K1
Practice Address - Street 2:
Practice Address - City:SUTTONS BAY
Practice Address - State:MI
Practice Address - Zip Code:49682-8422
Practice Address - Country:US
Practice Address - Phone:231-386-0088
Practice Address - Fax:855-537-4321
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114789110Medicaid
MI774789110Medicaid
MIJP015389OtherBLUE CROSS BLUE SHIELD BLUE CARE NETWORK LICENSE
MI080A760010OtherBCBS
MI70-0-A7-6020-0OtherBLUE CROSS BLUE SHIELD BLUE CARE NETWORK PIN
MI080A760010OtherBCBS
OA76001035Medicare ID - Type Unspecified