Provider Demographics
NPI:1194149963
Name:YK2YK IOM, LLC
Entity type:Organization
Organization Name:YK2YK IOM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YADRANKO
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-908-8124
Mailing Address - Street 1:1700 GLADE ROAD
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034
Mailing Address - Country:US
Mailing Address - Phone:817-908-8124
Mailing Address - Fax:817-885-7339
Practice Address - Street 1:1700 GLADE ROAD
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034
Practice Address - Country:US
Practice Address - Phone:817-908-8124
Practice Address - Fax:817-885-7339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3716207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty