Provider Demographics
NPI:1003894619
Name:YODER, CORDELL L (MD)
Entity Type:Individual
Prefix:DR
First Name:CORDELL
Middle Name:L
Last Name:YODER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1701 SOUTH BLVD EAST
Mailing Address - Street 2:STE 250
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307
Mailing Address - Country:US
Mailing Address - Phone:248-293-1002
Mailing Address - Fax:248-293-1272
Practice Address - Street 1:1701 SOUTH BLVD EAST
Practice Address - Street 2:STE 250
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:248-293-1002
Practice Address - Fax:248-293-1272
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074814207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110F374450OtherBCBS
MI4509997Medicaid
MIP31222FOtherBCN
MIP31222FOtherBCN
OM73290005Medicare ID - Type Unspecified