Provider Demographics
NPI:1831203256
Name:YACISEN, JOSEPH RICHARD (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:RICHARD
Last Name:YACISEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 845
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-0845
Mailing Address - Country:US
Mailing Address - Phone:989-466-2663
Mailing Address - Fax:989-466-4748
Practice Address - Street 1:315 E WARWICK DR
Practice Address - Street 2:STE B
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1083
Practice Address - Country:US
Practice Address - Phone:989-466-2663
Practice Address - Fax:989-466-4748
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012516207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2057201025OtherBCBS
MI114737704Medicaid
MI5720102OtherBLUE CARE NETWORK
MI2057201025OtherBCBS
MI114737704Medicaid