Individual
CHARLES MICHAEL YANCEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
1700 HIGHWAY 25 N, BUFFALO, MN 55313-1930
(763) 682-9241
(763) 684-1040
Mailing address
5851 DULUTH ST, STE 215, GOLDEN VALLEY, MN 55422-3956
(763) 546-8422
(763) 546-8114
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
33668
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0829240
MEDICA CHOICE
MN
01
—
180018037
RAILROAD MEDICARE
MN
05
—
285002800
—
MN
01
—
4T688YA
BCBS OF MN
MN
Enumeration date
06/27/2005
Last updated
04/23/2013
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