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General NPI Number Information
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NPI Number | 1134329477
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Entity Type | Organization
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Legal Business Name | YESSENOW CENTRE, P.C.
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 11/23/2009
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Provider Practice Location Address
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Address Line | 9250 COLUMBIA AVE SUITE A-2
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City | MUNSTER
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State | IN
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Zip | 46321-3538
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Country | US
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Telephone | 219-836-8136
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Fax | 219-836-8135
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Provider Business Mailing Address
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Address Line | 9250 COLUMBIA AVE SUITE A-2
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City | MUNSTER
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State | IN
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Zip | 46321-3538
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Country | US
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Telephone | 219-836-8136
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Fax | 219-836-8135
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. VALORIE PECK
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Credential |
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Telephone | 219-836-8136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 01039206A
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License Number State | IN
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