Healthcare Provider Details

I. General information

NPI: 1942391891
Provider Name (Legal Business Name): DR. MICHAEL YUNES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 MAIN ST
SPRINGFIELD MA
01107-1112
US

IV. Provider business mailing address

15 PINE MEADOW DR
SOUTHAMPTON MA
01073-9701
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-9175
  • Fax:
Mailing address:
  • Phone: 413-794-9175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number220164
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: