Basic Information
| Provider Information | |||||||||
| NPI: | 1376751529 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YEE | ||||||||
| FirstName: | WALTER | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7210 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622233038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183940712 | ||||||||
| FaxNumber: | 6183941346 | ||||||||
| Practice Location | |||||||||
| Address1: | 7210 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622233038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183940712 | ||||||||
| FaxNumber: | 6183941346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2007 | ||||||||
| LastUpdateDate: | 09/02/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 5101019561 | MI | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 036-135855 | IL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 700G36110 | 01 | MI | BC PPO TRUST | OTHER | 700G361110 | 01 | MI | BLUE CROSS BLUE SHIELD TRADITIONAL | OTHER | 1376751529 | 05 | MI | MEDICAID | 700G361110 | 01 | MI | BCN COMMERICAL | OTHER | 700G361110 | 01 | MI | BLUE PREFERREDPLUS BPP | OTHER | 700G361110 | 01 | MI | MEDICARE PLUS BLUE PPO | OTHER | 71364 | 01 | MI | HEALTH PLAN OF MICHIGAN | OTHER |