Provider Demographics
NPI:1225072002
Name:YATES, ISAURE EVE (MD)
Entity Type:Individual
Prefix:
First Name:ISAURE
Middle Name:EVE
Last Name:YATES
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 1:17800 NEWBURGH RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2700
Mailing Address - Country:US
Mailing Address - Phone:734-464-9540
Mailing Address - Fax:734-464-0438
Practice Address - Street 1:17800 NEWBURGH RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2700
Practice Address - Country:US
Practice Address - Phone:734-464-9540
Practice Address - Fax:734-464-0438
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1603207Q00000X
MI4301077544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100191485Medicaid