Provider Demographics
NPI:1679665749
Name:YESUS, YOHANNES W (MD)
Entity Type:Individual
Prefix:DR
First Name:YOHANNES
Middle Name:W
Last Name:YESUS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1169 EASTERN PKWY
Mailing Address - Street 2:SUITE G71
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1417
Mailing Address - Country:US
Mailing Address - Phone:502-456-6212
Mailing Address - Fax:502-456-4440
Practice Address - Street 1:1220 MISSOURI AVE
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3725
Practice Address - Country:US
Practice Address - Phone:812-283-2169
Practice Address - Fax:502-456-4440
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-09-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY36204207ZP0102X
IN01051747207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64021199Medicaid
IN200268960AMedicaid
KY3471714000OtherPASSPORT ADVANTAGE
INP00430453OtherMEDICARE RR
KY50022834OtherPASSPORT
IN000000528992OtherANTHEM
KY64021199Medicaid
KY50022834OtherPASSPORT
IN200268960AMedicaid