Provider Demographics
NPI:1770819567
Name:YODER, WILLIAM ALLEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALLEN
Last Name:YODER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 30TH AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1632
Mailing Address - Country:US
Mailing Address - Phone:262-657-6104
Mailing Address - Fax:262-657-6194
Practice Address - Street 1:3535 30TH AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1632
Practice Address - Country:US
Practice Address - Phone:262-657-6104
Practice Address - Fax:262-657-6194
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003528213ES0103X
WI988-025213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1417141227OtherNPPES
WI000046034Medicare PIN
WI1417141227OtherNPPES