Provider Demographics
NPI:1194974600
Name:YADAVA, GAURAV (MD)
Entity type:Individual
Prefix:DR
First Name:GAURAV
Middle Name:
Last Name:YADAVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S YORK ST STE 4150
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5630
Mailing Address - Country:US
Mailing Address - Phone:630-530-5577
Mailing Address - Fax:630-530-4477
Practice Address - Street 1:1200 S YORK ST STE 4150
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5630
Practice Address - Country:US
Practice Address - Phone:630-530-5577
Practice Address - Fax:630-530-4477
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV207732084N0402X
IL0361218222084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology