Provider Demographics
NPI:1124054614
Name:YEAMANS, JEFFREY CHARLES (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:CHARLES
Last Name:YEAMANS
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 1:18325 10 MILE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066
Mailing Address - Country:US
Mailing Address - Phone:586-773-6300
Mailing Address - Fax:586-773-6266
Practice Address - Street 1:18325 10 MILE
Practice Address - Street 2:SUITE 200
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066
Practice Address - Country:US
Practice Address - Phone:586-773-6300
Practice Address - Fax:586-773-6266
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087109208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3405019452OtherBCBSM PIN
MIP00433547OtherRAILROAD MEDICARE PIN
JY087109OtherLICENSE
MI4894439Medicaid
MI4894439Medicaid
MI1005840001Medicare NSC
MI0M07510008Medicare PIN