Provider Demographics
NPI:1043389240
Name:JOSEPH R YACISEN DO PC
Entity Type:Organization
Organization Name:JOSEPH R YACISEN DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:YACISEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-466-2663
Mailing Address - Street 1:315 E WARWICK DR
Mailing Address - Street 2:STE B
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1083
Mailing Address - Country:US
Mailing Address - Phone:989-466-2663
Mailing Address - Fax:989-466-4748
Practice Address - Street 1:315 E WARWICK DR
Practice Address - Street 2:SUITE B
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1083
Practice Address - Country:US
Practice Address - Phone:989-466-2663
Practice Address - Fax:989-466-4748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012516207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4926111/11Medicaid
MIJY012516OtherLICENSE
MIJY012516OtherLICENSE
MIP1605001Medicare ID - Type UnspecifiedMEDICARE NUMBER
6333120003Medicare NSC