Provider Demographics
NPI:1972701159
Name:I. DAVID YANGA, M.D., P.C.
Entity type:Organization
Organization Name:I. DAVID YANGA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISMAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:YANGA
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:517-548-5000
Mailing Address - Street 1:1315 BYRON RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-1008
Mailing Address - Country:US
Mailing Address - Phone:517-548-5000
Mailing Address - Fax:517-548-9058
Practice Address - Street 1:1315 BYRON RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1008
Practice Address - Country:US
Practice Address - Phone:517-548-5000
Practice Address - Fax:517-548-9058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5214028Medicaid
1184760670OtherPERSONAL NATIONAL PROVID
1184760670OtherPERSONAL NATIONAL PROVID