MEDICARE: YESSENOW CENTRE, P.C.

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	208200000X	Plastic Surgery Physician	01039206A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	942359	OTHER	IN	UNITED HEALTHCARE NO.
2	88688	OTHER	IN	ANTHEM PROVIDER NO.
3	1859137007	OTHER	IN	CIGNA PROVIDER NO.
4	4411395	OTHER	IN	AETNA PROVIDER NO.
5	911-08053	OTHER	IN	BC/BS OF IL PROVIDER NO.

General Provider Information

NPI Number	:	1134329477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YESSENOW CENTRE, P.C.

Provider Business Mailing Address
First Line	:	9250 COLUMBIA AVE
Second Line	:	SUITE A-2
City	:	MUNSTER
State	:	IN
Zip	:	46321-3538
Country	:	US
Telephone Number	:	219-836-8136
Fax Number	:	219-836-8135

Provider Business Practice Location Address
First Line	:	9250 COLUMBIA AVE
Second Line	:	SUITE A-2
City	:	MUNSTER
State	:	IN
Zip	:	46321-3538
Country	:	US
Telephone Number	:	219-836-8136
Fax Number	:	219-836-8135

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. VALORIE PECK
Credential	:
Telephone Number	:	219-836-8136

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	11/23/2009

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Directions to “YESSENOW CENTRE, P.C. ” Practice Location

Language	Start Address	Practice Location

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