Provider Demographics
NPI:1538263074
Name:YODER, CARLA GRIEBEL (MD)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:GRIEBEL
Last Name:YODER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CARLA
Other - Middle Name:GRIEBEL
Other - Last Name:MISHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1811 CHARLTON CT
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-6464
Mailing Address - Country:US
Mailing Address - Phone:574-534-0050
Mailing Address - Fax:574-534-0411
Practice Address - Street 1:1811 CHARLTON CT
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6464
Practice Address - Country:US
Practice Address - Phone:574-534-8200
Practice Address - Fax:574-534-0411
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039543207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100350450AMedicaid
IN100350450AMedicaid
IN080172971Medicare PIN