Healthcare Provider Details

I. General information

NPI: 1982691127
Provider Name (Legal Business Name): MICHAEL WAYNE YERKEY M.D., F.A.C.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W BROADWAY ST
MISSOULA MT
59802
US

IV. Provider business mailing address

PO BOX 12
LIBERTY LAKE WA
99019-0012
US

V. Phone/Fax

Practice location:
  • Phone: 406-329-5615
  • Fax: 406-329-2791
Mailing address:
  • Phone: 406-329-5615
  • Fax: 406-329-2659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMED-PHYS-LIC-18387
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMED-PHYS-LIC-18387
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: