Healthcare Provider Details

I. General information

NPI: 1831203256
Provider Name (Legal Business Name): JOSEPH RICHARD YACISEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E WARWICK DR STE B
ALMA MI
48801-1083
US

IV. Provider business mailing address

PO BOX 845
ALMA MI
48801-0845
US

V. Phone/Fax

Practice location:
  • Phone: 989-466-2663
  • Fax: 989-466-4748
Mailing address:
  • Phone: 989-466-2663
  • Fax: 989-466-4748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101012516
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: