Provider Demographics
NPI:1184167595
Name:JOSEPH YACISEN, DO, PC
Entity type:Organization
Organization Name:JOSEPH YACISEN, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-466-2663
Mailing Address - Street 1:2130 MARSHALL CT
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-3351
Mailing Address - Country:US
Mailing Address - Phone:989-466-2663
Mailing Address - Fax:989-466-4748
Practice Address - Street 1:2130 MARSHALL CT
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3351
Practice Address - Country:US
Practice Address - Phone:989-466-2663
Practice Address - Fax:989-466-4748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJY012516174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114926111Medicaid
MI114926111Medicaid