Individual
CHUCK YADMARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
31610 PLYMOUTH RD, LIVONIA, MI 48150-1930
(734) 421-2840
(734) 421-4045
Mailing address
31610 PLYMOUTH RD, LIVONIA, MI 48150-1932
(734) 421-2840
(734) 421-4045
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
CY063359
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080H24860
BLUE CROSS BLUE SHIELD
MI
01
—
383344395
TAX ID
MI
01
—
CY063359
STATE LICENSE
MI
Enumeration date
08/28/2006
Last updated
10/17/2023
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