Provider Demographics
NPI:1356953376
Name:YAX, EDDY JAMES
Entity type:Individual
Prefix:
First Name:EDDY
Middle Name:JAMES
Last Name:YAX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9065 TIMBERCREST LN
Mailing Address - Street 2:
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189-8207
Mailing Address - Country:US
Mailing Address - Phone:734-502-8924
Mailing Address - Fax:
Practice Address - Street 1:9065 TIMBERCREST LN
Practice Address - Street 2:
Practice Address - City:WHITMORE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48189-8207
Practice Address - Country:US
Practice Address - Phone:734-502-8924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health