1912046020 NPI number — YVON NAZON MD SC

Table of content: (NPI 1912046020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912046020 NPI number — YVON NAZON MD SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YVON NAZON MD SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1912046020
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6111 HARRISON ST
Provider Second Line Business Mailing Address:
STE 308
Provider Business Mailing Address City Name:
MERRILLVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46410-2969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-734-7551
Provider Business Mailing Address Fax Number:
708-585-0211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6111 HARRISON ST
Provider Second Line Business Practice Location Address:
STE 308
Provider Business Practice Location Address City Name:
MERRILLVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46410-2969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-734-7551
Provider Business Practice Location Address Fax Number:
708-585-0211
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NAZON
Authorized Official First Name:
YVON
Authorized Official Middle Name:
JEUNE
Authorized Official Title or Position:
PRESIDENT/TREASURER
Authorized Official Telephone Number:
773-734-7551

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  01021678C , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: 01021678 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100438330 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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