Basic Information
| Provider Information | |||||||||
| NPI: | 1891131959 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YAM | ||||||||
| FirstName: | JULIE | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 788 SERVICE ROAD, ROOM B301 | ||||||||
| Address2: | MSU CLINICAL CENTER | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173535100 | ||||||||
| FaxNumber: | 5174322759 | ||||||||
| Practice Location | |||||||||
| Address1: | 138 SERVICE RD | ||||||||
| Address2: | A225 CLINICAL CENTER | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488241376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173534941 | ||||||||
| FaxNumber: | 5174323145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2013 | ||||||||
| LastUpdateDate: | 11/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5101020259 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 5101020259 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 1891131959 | 05 | MI | MEDICAID |