1790719128 NPI number — MICHAEL YANKOWITZ DPM

Table of content: MICHAEL YANKOWITZ DPM (NPI 1790719128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790719128 NPI number — MICHAEL YANKOWITZ DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YANKOWITZ
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1790719128
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 68
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FESTUS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63028-0068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-933-4100
Provider Business Mailing Address Fax Number:
636-937-3788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1216 W MAIN ST LOWR LEVEL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FESTUS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63028-1654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-933-4100
Provider Business Practice Location Address Fax Number:
636-937-3788
Provider Enumeration Date:
07/10/2006

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: 213ES0131X , with the licence number:  000621 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 172665 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 303003206 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 431576335 . This is a "TAX ID" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 177893 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 43576335 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: W5876 . This is a "MERCY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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