Provider Demographics
NPI:1477555670
Name:YEHYAWI, KAIS (MD)
Entity Type:Individual
Prefix:
First Name:KAIS
Middle Name:
Last Name:YEHYAWI
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 1:6375 US HIGHWAY 6 STE B
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-5218
Mailing Address - Country:US
Mailing Address - Phone:219-762-0400
Mailing Address - Fax:219-762-2460
Practice Address - Street 1:6375 US HIGHWAY 6 STE B
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-5218
Practice Address - Country:US
Practice Address - Phone:219-762-0400
Practice Address - Fax:219-762-2460
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055547A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200350030Medicaid
IN200293540AMedicaid
IN192820MMedicare PIN
IN200350030Medicaid
IN221020BMedicare PIN
F70443Medicare UPIN
IN060067947Medicare PIN
IN200293540AMedicaid
IN496850KMedicare PIN