Provider Demographics
NPI:1336193465
Name:YSON, ANGELINO S (MD)
Entity Type:Individual
Prefix:
First Name:ANGELINO
Middle Name:S
Last Name:YSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANGELINO
Other - Middle Name:
Other - Last Name:YSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-253-1035
Mailing Address - Fax:502-253-1037
Practice Address - Street 1:4003 KRESGE WAY
Practice Address - Street 2:SUITE 400
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4652
Practice Address - Country:US
Practice Address - Phone:502-895-4263
Practice Address - Fax:502-899-5488
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27613207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000575262OtherANTHEM - NCMA
KYP00655716OtherRAILROAD MCR - NMA
KY3534949000OtherPASSPORT ADVTG - NMA
KY3759061000OtherPASSPORT ADVTG - NCMA
KY64276132Medicaid
KY097760OtherSIHO
KY2432738000Medicaid
IN200035830OtherMEDICAID-IN - NMA
KY50027043OtherPASSPORT - NCMA
KY5020165OtherPASSPORT - NMA
KY000023033QOtherHUMANA
KY00533053OtherMEDICARE - KY - NMA
KY0994672OtherCIGNA - NMA
KY000000614192OtherANTHEM - NMA
KY64276132OtherMEDICAID-KY - NMA
KY3534949000OtherPASSPORT ADVTG - NMA
KY000000575262OtherANTHEM - NCMA
KY2432738000Medicaid