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General NPI Number Information
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NPI Number | 1154645901
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Entity Type | Organization
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Legal Business Name | JOSPEH R YACISEN DO PC
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 05/04/2010
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Provider Practice Location Address
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Address Line | 602 BEECH ST STE 1200
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City | CLARE
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State | MI
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Zip | 48617-1466
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Country | US
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Telephone | 989-802-5080
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Fax | 989-802-5090
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Provider Business Mailing Address
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Address Line | 315 E WARWICK DR STE B
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City | ALMA
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State | MI
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Zip | 48801-1083
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Country | US
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Telephone | 989-466-2663
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Fax | 989-466-4748
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH R YACISEN
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Credential | D.O.
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Telephone | 989-466-2663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | JY012516
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License Number State | MI
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