Organization
YESSENOW CENTRE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VALORIE PECK (OFFICE MANAGER)
(219) 836-8136
Entity
Organization
Contact information
Practice address
9250 COLUMBIA AVE, SUITE A-2, MUNSTER, IN 46321-3538
(219) 836-8136
(219) 836-8135
Mailing address
9250 COLUMBIA AVE, SUITE A-2, MUNSTER, IN 46321-3538
(219) 836-8136
(219) 836-8135
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
01039206A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1859137007
CIGNA PROVIDER NO.
IN
01
—
4411395
AETNA PROVIDER NO.
IN
01
—
88688
ANTHEM PROVIDER NO.
IN
01
—
911-08053
BC/BS OF IL PROVIDER NO.
IN
01
—
942359
UNITED HEALTHCARE NO.
IN
Enumeration date
07/24/2007
Last updated
11/23/2009
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