Individual
JOHN YACOUB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2723 S 7TH ST, SUITE A, TERRE HAUTE, IN 47802-3558
(812) 232-8164
(812) 234-6391
Mailing address
2723 S 7TH ST, SUITE A, TERRE HAUTE, IN 47802-3558
(812) 238-1730
(812) 242-1565
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
01062336A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000501251
ANTHEM PIN
IN
05
—
200850550
—
IN
01
—
P00404189
RAILROAD MEDICARE
IN
Enumeration date
07/09/2006
Last updated
06/06/2011
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