Healthcare Provider Details

I. General information

NPI: 1437202215
Provider Name (Legal Business Name): ORTHOPEDIC SURGEONS OF KOKOMO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 W ALTO RD
KOKOMO IN
46902-4840
US

IV. Provider business mailing address

2226 W ALTO RD
KOKOMO IN
46902-4840
US

V. Phone/Fax

Practice location:
  • Phone: 765-868-0313
  • Fax: 765-454-0554
Mailing address:
  • Phone: 765-868-0313
  • Fax: 765-454-0554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY DEAN YODER
Title or Position: OWNER
Credential: M.D.
Phone: 765-868-0313