Provider Demographics
NPI:1609404532
Name:YELICH, ALLYSON BROOKE (DO)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:BROOKE
Last Name:YELICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:BROOKE
Other - Last Name:BRAHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:1821 SOUTH AVE W STE 402
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6518
Practice Address - Country:US
Practice Address - Phone:406-543-8512
Practice Address - Fax:406-541-8513
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
MTMED-PHYS-LIC-134483207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207N00000XAllopathic & Osteopathic PhysiciansDermatology