Provider Demographics
NPI:1356543219
Name:ROBERT A. YAGOOBIAN, D.P.M., P.C.
Entity type:Organization
Organization Name:ROBERT A. YAGOOBIAN, D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARECLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-292-8400
Mailing Address - Street 1:23234 ECORSE RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-1769
Mailing Address - Country:US
Mailing Address - Phone:313-292-8400
Mailing Address - Fax:313-292-8430
Practice Address - Street 1:23234 ECORSE RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1769
Practice Address - Country:US
Practice Address - Phone:313-292-8400
Practice Address - Fax:313-292-8430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5446920001Medicare NSC