Provider Demographics
NPI:1386812253
Name:MAKEYEV, YAN G (MD)
Entity type:Individual
Prefix:DR
First Name:YAN
Middle Name:G
Last Name:MAKEYEV
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 1:2160 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1410
Mailing Address - Country:US
Mailing Address - Phone:239-931-7212
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:2141 LOCH RANE BLVD STE 116
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073
Practice Address - Country:US
Practice Address - Phone:904-427-1270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244912207RH0003X
FLME117262207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009397000Medicaid
FL9607624OtherAETNA
FLP01327652OtherRR MEDICARE
FL1193393OtherWELLCARE
FLP0026508OtherFLORIDA HEALTHCARE PLUS
FL14RW6OtherBCBS
FL1108013OtherCARE PLUS HEALTH PLANS
FL8268321OtherCIGNA
FL922243OtherWELLCARE
FLP01593274OtherRR MEDICARE
FL368661OtherAVMED
FLHM455YMedicare PIN
FLHM455WMedicare PIN
FL009397000Medicaid
FL922243OtherWELLCARE
FL8268321OtherCIGNA