Individual
DR. MICHAEL JOHN YANISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5823 W EUGIE AVE, STE A, GLENDALE, AZ 85304-1276
(602) 843-1265
(602) 843-1297
Mailing address
3020 E CAMELBACK RD, SUITE 300, PHOENIX, AZ 85016-5095
(602) 264-9100
(602) 264-9101
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
17047
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
120390
GROUP MEDICARE NUMBER
AZ
05
—
271164 01
—
AZ
05
—
271164-05
—
AZ
01
—
317047
GROUP MEDICAID NUMBER
AZ
Enumeration date
02/28/2006
Last updated
02/16/2017
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