Provider Demographics
NPI:1942301718
Name:YANKOVICH, SUSAN ANN (MD)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:ANN
Last Name:YANKOVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E SUPERIOR ST
Mailing Address - Street 2:STE. L401
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2207
Mailing Address - Country:US
Mailing Address - Phone:218-249-7960
Mailing Address - Fax:218-249-7997
Practice Address - Street 1:1001 E SUPERIOR ST
Practice Address - Street 2:STE. L401
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2207
Practice Address - Country:US
Practice Address - Phone:218-249-7960
Practice Address - Fax:218-249-7997
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN56318207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine