Provider Demographics
NPI:1598721722
Name:YADAO, PETRONIO C (MD)
Entity Type:Individual
Prefix:DR
First Name:PETRONIO
Middle Name:C
Last Name:YADAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:85 W HICKORY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-2113
Mailing Address - Country:US
Mailing Address - Phone:734-283-4616
Mailing Address - Fax:734-283-5430
Practice Address - Street 1:15350 TRENTON RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2027
Practice Address - Country:US
Practice Address - Phone:734-283-4616
Practice Address - Fax:734-283-5430
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031996208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1062429Medicaid
MI1062429Medicaid