Individual
YAN V YATSYNOVICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
228 W 4TH ST, COOKEVILLE, TN 38501-2488
(931) 372-0405
Mailing address
140 W 7TH ST, COOKEVILLE, TN 38501-1726
(931) 783-5582
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
64321
TN
207RC0000X
Cardiovascular Disease Physician
64321
TN
207RI0011X
Interventional Cardiology Physician
Primary
64321
TN
207UN0901X
Nuclear Cardiology Physician
64321
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
T24986A
—
TN
Enumeration date
04/22/2015
Last updated
09/26/2022
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