Provider Demographics
NPI:1437145281
Name:YATISH GOYAL MD INC
Entity Type:Organization
Organization Name:YATISH GOYAL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YATISH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOYAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-725-7277
Mailing Address - Street 1:970 E WASHINGTON ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3332
Mailing Address - Country:US
Mailing Address - Phone:330-725-7277
Mailing Address - Fax:330-725-7266
Practice Address - Street 1:970 E WASHINGTON ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3332
Practice Address - Country:US
Practice Address - Phone:330-725-7277
Practice Address - Fax:330-725-7266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074511G207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0884014OtherMEDICARE PIN#
OH2138261Medicaid
OH0884012OtherMEDICARE PIN#
OH0884014OtherMEDICARE PIN#
G64287Medicare UPIN