Provider Demographics
NPI:1124012992
Name:YURKO, MARY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:YURKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 MICHIGAN ST NE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3523
Mailing Address - Country:US
Mailing Address - Phone:616-459-1440
Mailing Address - Fax:616-459-0313
Practice Address - Street 1:833 MICHIGAN ST NE
Practice Address - Street 2:SUITE 102
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3523
Practice Address - Country:US
Practice Address - Phone:616-459-1440
Practice Address - Fax:616-459-0313
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066888207N00000X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
070D12389OtherBLUE CROSS
MIM16593Medicare UPIN
N13100002Medicare ID - Type Unspecified
MI0704104912OtherBLUE CROSS & BLUE SHIELD