Provider Demographics
NPI:1699762799
Name:YACK, CATHERINE LOUISE (DPM)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:LOUISE
Last Name:YACK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 FRANKLIN ST SE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4551
Mailing Address - Country:US
Mailing Address - Phone:256-533-3668
Mailing Address - Fax:256-533-2577
Practice Address - Street 1:2006 FRANKLIN ST SE
Practice Address - Street 2:SUITE 106
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4551
Practice Address - Country:US
Practice Address - Phone:256-533-3668
Practice Address - Fax:256-533-2577
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00129213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL444473626Medicaid
AL444473626Medicare ID - Type Unspecified
ALT89090Medicare UPIN