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NPI Code Detail

MEDICARE: CHARLES MICHAEL YANCEY MD, PHD

MEDICARE: CHARLES MICHAEL YANCEY MD, PHD
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
1207W00000XOphthalmology Physician33668MN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2180018037OTHERMNRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10829240OTHERMNMEDICA CHOICE
34T688YAOTHERMNBCBS OF MN
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255337978
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES MICHAEL YANCEY MD, PHD
Provider Business Mailing Address
First Line : 5851 DULUTH ST
Second Line : STE 215
City : GOLDEN VALLEY
State : MN
Zip : 55422-3956
Country : US
Telephone Number : 763-546-8422
Fax Number : 763-546-8114
Provider Business Practice Location Address
First Line : 1700 HIGHWAY 25 N
Second Line :
City : BUFFALO
State : MN
Zip : 55313-1930
Country : US
Telephone Number : 763-682-9241
Fax Number : 763-684-1040
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 04/23/2013

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