Provider Demographics
NPI:1790761294
Name:YOON, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:YOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01949-2446
Mailing Address - Country:US
Mailing Address - Phone:978-774-2555
Mailing Address - Fax:978-774-8517
Practice Address - Street 1:147 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:MA
Practice Address - Zip Code:01949-2446
Practice Address - Country:US
Practice Address - Phone:978-774-2555
Practice Address - Fax:978-774-8715
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159307207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30200468Medicaid
NHH02172Medicare UPIN
NHRE5430Medicare ID - Type Unspecified