MEDICARE: JUSTIN YEH M.D.

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	207Q00000X	Family Medicine Physician	11018743A	IN

General Provider Information

NPI Number	:	1114376662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN YEH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1510
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47706-1510
Country	:	US
Telephone Number	:	812-868-5030
Fax Number	:	812-868-2188

Provider Business Practice Location Address
First Line	:	4949 HEALTHY WAY STE A
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-1180
Country	:	US
Telephone Number	:	812-868-5030
Fax Number	:	812-868-2188

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

Provider Enumeration Date	:	06/06/2016
Last Update Date	:	08/05/2019

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