MEDICARE: YULIA PENISTON DO

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	207V00000X	Obstetrics & Gynecology Physician	2011021726	MO

General Provider Information

NPI Number	:	1750582516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YULIA PENISTON DO

Provider Business Mailing Address
First Line	:	861 FAIRWAY DR
Second Line	:
City	:	CHILLICOTHEE
State	:	MO
Zip	:	64601-3673
Country	:	US
Telephone Number	:	913-680-9830
Fax Number	:

Provider Business Practice Location Address
First Line	:	861 FAIRWAY DR
Second Line	:
City	:	CHILLICOTHEE
State	:	MO
Zip	:	64601-3673
Country	:	US
Telephone Number	:	913-680-9830
Fax Number	:

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	02/01/2022

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Directions to “ YULIA PENISTON DO” Practice Location

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