MEDICARE: DR. GEORGE YAKUBEK D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208D00000X	General Practice Physician	34.012705	OH

General Provider Information

NPI Number	:	1083091367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE YAKUBEK D.O.

Provider Business Mailing Address
First Line	:	7841 CASTLE ROCK DR NE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-1410
Country	:	US
Telephone Number	:	330-307-4718
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-1010
Country	:	US
Telephone Number	:	216-444-6013
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2015
Last Update Date	:	11/20/2023

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