Provider Demographics
NPI:1215032644
Name:PACQUING, YVONNE V (MD)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:V
Last Name:PACQUING
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 1:4855 BERL DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2832
Mailing Address - Country:US
Mailing Address - Phone:989-793-6373
Mailing Address - Fax:989-793-7649
Practice Address - Street 1:4684 WENMAR DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2817
Practice Address - Country:US
Practice Address - Phone:989-793-6373
Practice Address - Fax:989-793-7649
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056422208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4411819Medicare ID - Type Unspecified
MIN73310003Medicare ID - Type Unspecified
MIF68344Medicare UPIN