Basic Information
| Provider Information | |||||||||
| NPI: | 1407349749 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YANOSCHIK | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 WESTWICK LN APT 6 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283142736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6167453984 | ||||||||
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| Practice Location | |||||||||
| Address1: | WOMACK ARMY MEDICAL CENTER 2817 REILLY RD | ||||||||
| Address2: | |||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283105001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109077136 | ||||||||
| FaxNumber: | 9109078631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2018 | ||||||||
| LastUpdateDate: | 04/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208D00000X | 32046 | NE | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.