Provider Demographics
NPI:1245456805
Name:MICHAEL D. YATES, MD, PC
Entity type:Organization
Organization Name:MICHAEL D. YATES, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-536-4448
Mailing Address - Street 1:303 WILLIAMS AV SW
Mailing Address - Street 2:SUITE 1421
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6008
Mailing Address - Country:US
Mailing Address - Phone:256-536-4448
Mailing Address - Fax:256-533-4583
Practice Address - Street 1:303 WILLIAMS AV SW
Practice Address - Street 2:SUITE 1421
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6008
Practice Address - Country:US
Practice Address - Phone:256-536-4448
Practice Address - Fax:256-533-4583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL152932086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000082255Medicaid
ALE68347Medicare UPIN
AL000082255Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER