1376751529 NPI number — WALTER J YEE D.O.

Table of content: WALTER J YEE D.O. (NPI 1376751529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376751529 NPI number — WALTER J YEE D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YEE
Provider First Name:
WALTER
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376751529
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7210 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62223-3038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-394-0712
Provider Business Mailing Address Fax Number:
618-394-1346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7210 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62223-3038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-394-0712
Provider Business Practice Location Address Fax Number:
618-394-1346
Provider Enumeration Date:
05/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  5101019561 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 036-135855 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 700G36110 . This is a "BC PPO TRUST" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700G361110 . This is a "BLUE CROSS BLUE SHIELD TRADITIONAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1376751529 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 700G361110 . This is a "BCN COMMERICAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700G361110 . This is a "BLUE PREFERREDPLUS BPP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700G361110 . This is a "MEDICARE PLUS BLUE PPO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 71364 . This is a "HEALTH PLAN OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com