Provider Demographics
NPI:1780674838
Name:YAREMO, THEODORE W (MD, PA)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:W
Last Name:YAREMO
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:THEODORE
Other - Middle Name:
Other - Last Name:YAREMO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PA
Mailing Address - Street 1:PO BOX 510550
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951-0550
Mailing Address - Country:US
Mailing Address - Phone:941-637-6380
Mailing Address - Fax:941-347-8244
Practice Address - Street 1:150 W MCKENZIE ST STE 117
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-5500
Practice Address - Country:US
Practice Address - Phone:941-637-6062
Practice Address - Fax:941-575-4449
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49299207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74616OtherBCBS GROUP #
FL05918OtherBCBS INDIVIDUAL #
FL05918OtherBCBS INDIVIDUAL #
FLK5946Medicare ID - Type UnspecifiedGROUP #
FL05918YMedicare ID - Type UnspecifiedINDIVIDUAL #
FLD61311Medicare UPIN