Provider Demographics
NPI:1457336331
Name:YEISER, MICHAEL F (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
Last Name:YEISER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 E. PARRISH AVE
Mailing Address - Street 2:BLDG B, STE 101
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1449
Mailing Address - Country:US
Mailing Address - Phone:270-683-3232
Mailing Address - Fax:270-852-1600
Practice Address - Street 1:2200 E. PARRISH AVE
Practice Address - Street 2:BLDG B, STE 101
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-683-3232
Practice Address - Fax:270-852-1600
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22750208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00000051444OtherBLUE CROSS
KY64227507Medicaid
00000051444OtherBC ID (INS)
KYC75371Medicare UPIN
KY64227507Medicaid
0650801Medicare ID - Type Unspecified
1281011Medicare PIN