Basic Information
| Provider Information | |||||||||
| NPI: | 1881628253 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EVERETT | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1035 W WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | ALPENA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497072929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897369815 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6135 CRESSY ST | ||||||||
| Address2: | |||||||||
| City: | INDIAN RIVER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2312388908 | ||||||||
| FaxNumber: | 2312384419 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 02/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5101010086 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0151600015 | 01 | MI | INDIVIDUAL BLUE CROSS | OTHER | 2800120 | 05 | MI | MEDICAID | 700A610050 | 01 | MI | GROUP BLUE CROSS | OTHER |