Provider Demographics
NPI:1144286857
Name:YOUGA, HENRY JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:JOSEPH
Last Name:YOUGA
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 1:428 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-1595
Mailing Address - Country:US
Mailing Address - Phone:231-299-1500
Mailing Address - Fax:231-299-1503
Practice Address - Street 1:428 1ST ST
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-1595
Practice Address - Country:US
Practice Address - Phone:231-299-1500
Practice Address - Fax:231-299-1503
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075778207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301075778OtherSTATE LICENSE
MI0803000512OtherBLUE CROSS BLUE SHIELD
MI4301075778OtherSTATE LICENSE