Provider Demographics
NPI:1386616407
Name:JAKEL, VICTORIA (MD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:JAKEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-0549
Mailing Address - Country:US
Mailing Address - Phone:906-774-1313
Mailing Address - Fax:906-776-5639
Practice Address - Street 1:N1667 US HIGHWAY 8
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:MI
Practice Address - Zip Code:49870-2003
Practice Address - Country:US
Practice Address - Phone:906-563-7323
Practice Address - Fax:906-563-7120
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056413207Q00000X
WI32586-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110B210270OtherBCBS
MI4710578Medicaid
WI31933900Medicaid
MI080070770OtherRR MEDICARE
1008923OtherPREFERRED ONE
MI0802281951OtherBX-MI
MI4710578Medicaid
MIOM24440-013Medicare ID - Type Unspecified
WI31933900Medicaid
MIB26002103Medicare PIN
WIWI1196002Medicare PIN