Provider Demographics
NPI:1881628253
Name:EVERETT, JOHN K (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:K
Last Name:EVERETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-2929
Mailing Address - Country:US
Mailing Address - Phone:989-736-9815
Mailing Address - Fax:
Practice Address - Street 1:6135 CRESSY ST
Practice Address - Street 2:
Practice Address - City:INDIAN RIVER
Practice Address - State:MI
Practice Address - Zip Code:49749
Practice Address - Country:US
Practice Address - Phone:231-238-8908
Practice Address - Fax:231-238-4419
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0151600015OtherINDIVIDUAL BLUE CROSS
MI2800120Medicaid
MI700A610050OtherGROUP BLUE CROSS
MI700A610050OtherGROUP BLUE CROSS
E26058Medicare UPIN