Provider Demographics
NPI:1790719128
Name:YANKOWITZ, MICHAEL (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:YANKOWITZ
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:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-0068
Mailing Address - Country:US
Mailing Address - Phone:636-933-4100
Mailing Address - Fax:636-937-3788
Practice Address - Street 1:1216 W MAIN ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-1654
Practice Address - Country:US
Practice Address - Phone:636-933-4100
Practice Address - Fax:636-937-3788
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000621213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO172665OtherHEALTHLINK
MO303003206Medicaid
MO431576335OtherTAX ID
MO177893OtherBLUE CROSS BLUE SHIELD
MO43576335OtherUNITED HEALTHCARE
MOW5876OtherMERCY
MO177893OtherBLUE CROSS BLUE SHIELD
MO0000021220Medicare NSC
MO172665OtherHEALTHLINK
5654400001Medicare NSC