Healthcare Provider Details

I. General information

NPI: 1801024781
Provider Name (Legal Business Name): ANDREW THOMAS YETMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 GULL RD
KALAMAZOO MI
49048-1640
US

IV. Provider business mailing address

1535 GULL RD MSB 015
KALAMAZOO MI
49048-1650
US

V. Phone/Fax

Practice location:
  • Phone: 269-226-6933
  • Fax:
Mailing address:
  • Phone: 269-226-6933
  • Fax: 269-226-6949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301095064
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: