Provider Demographics
NPI:1467524603
Name:YERAS, ALLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLA
Middle Name:
Last Name:YERAS
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 1:1460 N CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1429
Mailing Address - Country:US
Mailing Address - Phone:810-715-4300
Mailing Address - Fax:
Practice Address - Street 1:4764 DIXIE HWY APT SUITE
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-3525
Practice Address - Country:US
Practice Address - Phone:248-775-0200
Practice Address - Fax:248-775-0202
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084137207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4626652Medicaid