Provider Demographics
NPI:1144574070
Name:CATHY YODER MD, LLC
Entity Type:Organization
Organization Name:CATHY YODER MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:YODER
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, CAPPM, EFPM
Authorized Official - Phone:317-402-8586
Mailing Address - Street 1:5955 S EMERSON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-2600
Mailing Address - Country:US
Mailing Address - Phone:317-426-1456
Mailing Address - Fax:317-472-7739
Practice Address - Street 1:5955 S EMERSON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-2600
Practice Address - Country:US
Practice Address - Phone:317-426-1456
Practice Address - Fax:317-472-7739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty