Provider Demographics
NPI:1508171810
Name:YAMAMOTO, JOSEPH MICHAEL E (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH MICHAEL
Middle Name:E
Last Name:YAMAMOTO
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3611 S REED RD
Practice Address - Street 2:STE 214
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3806
Practice Address - Country:US
Practice Address - Phone:765-864-8700
Practice Address - Fax:765-864-8715
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11015799A207Q00000X
IN01072129A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01270967OtherRR MEDICARE
IN201096400Medicaid
IN227540002Medicare PIN
IN201096400Medicaid
INP01270967OtherRR MEDICARE