Provider Demographics
NPI: | 1043492184 |
---|---|
Name: | YANG, MICHAEL (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | MICHAEL |
Middle Name: | |
Last Name: | YANG |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 110429 |
Mailing Address - Street 2: | |
Mailing Address - City: | AURORA |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80042-0429 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 12605 E 16TH AVE |
Practice Address - Street 2: | |
Practice Address - City: | AURORA |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80045-2545 |
Practice Address - Country: | US |
Practice Address - Phone: | 720-777-1234 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-11-30 |
Last Update Date: | 2020-07-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 35-093441 | 207ZC0006X, 207ZC0500X, 207ZB0001X, 207ZD0900X, 207ZF0201X, 207ZH0000X, 207ZI0100X, 207ZM0300X, 207ZN0500X, 207ZP0007X, 207ZP0101X, 207ZP0102X, 207ZP0104X, 207ZP0213X |
CO | DR.0063375 | 207ZP0102X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No | 207ZC0006X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology |
No | 207ZC0500X | Allopathic & Osteopathic Physicians | Pathology | Cytopathology |
No | 207ZB0001X | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine |
No | 207ZD0900X | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology |
No | 207ZF0201X | Allopathic & Osteopathic Physicians | Pathology | Forensic Pathology |
No | 207ZH0000X | Allopathic & Osteopathic Physicians | Pathology | Hematology |
No | 207ZI0100X | Allopathic & Osteopathic Physicians | Pathology | Immunopathology |
No | 207ZM0300X | Allopathic & Osteopathic Physicians | Pathology | Medical Microbiology |
No | 207ZN0500X | Allopathic & Osteopathic Physicians | Pathology | Neuropathology |
No | 207ZP0007X | Allopathic & Osteopathic Physicians | Pathology | Molecular Genetic Pathology |
No | 207ZP0101X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
No | 207ZP0104X | Allopathic & Osteopathic Physicians | Pathology | Chemical Pathology |
No | 207ZP0213X | Allopathic & Osteopathic Physicians | Pathology | Pediatric Pathology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 2938576 | Medicaid | |
OH | 2938576 | Medicaid | |
OH | YA4265361 | Medicare PIN |