Provider Demographics
NPI:1215997440
Name:YATES, JUDITH M (MD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:M
Last Name:YATES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:YATES
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5015 N ROYAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684
Mailing Address - Country:US
Mailing Address - Phone:231-935-0850
Mailing Address - Fax:231-935-0869
Practice Address - Street 1:5015 N ROYAL DRIVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-935-0850
Practice Address - Fax:231-935-0869
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2657328Medicaid
MI1102802970OtherBCBSM
MI0B86407Medicare PIN
A76822Medicare UPIN
MI2657328Medicaid