Provider Demographics
NPI:1134336035
Name:YU-MENDADOR, ROWENA C (MD)
Entity type:Individual
Prefix:
First Name:ROWENA
Middle Name:C
Last Name:YU-MENDADOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROWENA
Other - Middle Name:C
Other - Last Name:YU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2708 GUILFORD ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-9701
Practice Address - Country:US
Practice Address - Phone:260-355-3900
Practice Address - Fax:260-355-3079
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01067337A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00895088OtherMEDICARE RR
IN000000671293OtherANTHEM
IN200970640Medicaid
INM400024753Medicare PIN
INM400024754Medicare PIN