Basic Information
| Provider Information | |||||||||
| NPI: | 1386616407 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAKEL | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 549 | ||||||||
| Address2: | |||||||||
| City: | IRON MOUNTAIN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498010549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9067741313 | ||||||||
| FaxNumber: | 9067765639 | ||||||||
| Practice Location | |||||||||
| Address1: | N1667 US HIGHWAY 8 | ||||||||
| Address2: | |||||||||
| City: | NORWAY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498702003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9065637323 | ||||||||
| FaxNumber: | 9065637120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 07/10/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301056413 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 32586-020 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110B210270 | 01 | MI | BCBS | OTHER | 4710578 | 05 | MI | MEDICAID | 31933900 | 05 | WI | MEDICAID | 080070770 | 01 | MI | RR MEDICARE | OTHER | 1008923 | 01 | PREFERRED ONE | OTHER | 0802281951 | 01 | MI | BX-MI | OTHER |