Provider Demographics
NPI:1457393605
Name:YEICH, STEPHEN M (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:YEICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 108835
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-8835
Mailing Address - Country:US
Mailing Address - Phone:405-775-9350
Mailing Address - Fax:405-775-9360
Practice Address - Street 1:3048 SW 89TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6385
Practice Address - Country:US
Practice Address - Phone:405-775-9350
Practice Address - Fax:405-775-9360
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2015-09-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK16055207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100222060AMedicaid
OK4960Medicare UPIN
OKOKB5458Medicare PIN