Provider Demographics
NPI:1518958008
Name:YANOVER, MELISSA J (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:YANOVER
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:PO BOX 970
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80038-0970
Mailing Address - Country:US
Mailing Address - Phone:303-777-3333
Mailing Address - Fax:303-733-4441
Practice Address - Street 1:850 E. HARVARD AVE
Practice Address - Street 2:SUITE 565
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-2028
Practice Address - Country:US
Practice Address - Phone:303-777-3333
Practice Address - Fax:303-733-4441
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO238222207RN0300X
CODR.0023822207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01238229Medicaid
COC810308Medicare PIN
D24333Medicare UPIN