Provider Demographics
NPI:1124051933
Name:YEDIDAG, EMRE N (MD)
Entity type:Individual
Prefix:DR
First Name:EMRE
Middle Name:N
Last Name:YEDIDAG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:NECMI
Other - Middle Name:EMRE
Other - Last Name:YEDIDAG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2003 W FULTON ST STE 3
Mailing Address - Street 2:C/O MR. SCOTT SCHNEIDER, PRESIDENT
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-2365
Mailing Address - Country:US
Mailing Address - Phone:773-292-4800
Mailing Address - Fax:773-486-3548
Practice Address - Street 1:2003 W FULTON ST STE 3
Practice Address - Street 2:C/O MR. SCOTT SCHNEIDER, PRESIDENT
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-2365
Practice Address - Country:US
Practice Address - Phone:773-292-4800
Practice Address - Fax:773-486-3548
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2005-0749208600000X
IL036.118805208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G05477Medicare UPIN