Provider Demographics
NPI:1255314910
Name:YEATMAN, DOUGLAS S (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:S
Last Name:YEATMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 W SCHROEDER DR
Mailing Address - Street 2:#170
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-1475
Mailing Address - Country:US
Mailing Address - Phone:414-365-3210
Mailing Address - Fax:
Practice Address - Street 1:842 N WESTHILL BLVD
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-5788
Practice Address - Country:US
Practice Address - Phone:920-738-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-26
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46834-020208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34538100Medicaid
I13282Medicare UPIN
WI000240240Medicare PIN