Basic Information
| Provider Information | |||||||||
| NPI: | 1457336331 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YEISER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 E. PARRISH AVE | ||||||||
| Address2: | BLDG B, STE 101 | ||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423031449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706833232 | ||||||||
| FaxNumber: | 2708521600 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 E. PARRISH AVE | ||||||||
| Address2: | BLDG B, STE 101 | ||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423031449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706833232 | ||||||||
| FaxNumber: | 2708521600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 11/10/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 22750 | KY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 00000051444 | 01 | KY | BLUE CROSS | OTHER | 64227507 | 05 | KY | MEDICAID | 00000051444 | 01 | BC ID (INS) | OTHER |