Healthcare Provider Details

I. General information

NPI: 1649271115
Provider Name (Legal Business Name): GARY STEVEN YASHINSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29355 NORTHWESTERN HWY STE. 120
SOUTHFIELD MI
48034-1053
US

IV. Provider business mailing address

750 STEPHENSON HWY PAYOR CONTRACT SERVICES
TROY MI
48083-1103
US

V. Phone/Fax

Practice location:
  • Phone: 248-223-9650
  • Fax: 248-223-9662
Mailing address:
  • Phone: 248-577-3517
  • Fax: 248-577-3526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301044190
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: