Provider Demographics
NPI:1376751529
Name:YEE, WALTER J (DO)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:J
Last Name:YEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7210 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-3038
Mailing Address - Country:US
Mailing Address - Phone:618-394-0712
Mailing Address - Fax:618-394-1346
Practice Address - Street 1:7210 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-3038
Practice Address - Country:US
Practice Address - Phone:618-394-0712
Practice Address - Fax:618-394-1346
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101019561207V00000X
IL036-135855207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700G36110OtherBC PPO TRUST
MI700G361110OtherBLUE CROSS BLUE SHIELD TRADITIONAL
MI1376751529Medicaid
MI700G361110OtherBCN COMMERICAL
MI700G361110OtherBLUE PREFERREDPLUS BPP
MI700G361110OtherMEDICARE PLUS BLUE PPO
MI71364OtherHEALTH PLAN OF MICHIGAN
MI700G361110OtherBLUE CROSS BLUE SHIELD TRADITIONAL