Provider Demographics
NPI:1285800409
Name:MARIO C. YU MD PC
Entity type:Organization
Organization Name:MARIO C. YU MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIVIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-629-8282
Mailing Address - Street 1:1919 MIDWEST RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1365
Mailing Address - Country:US
Mailing Address - Phone:630-629-8282
Mailing Address - Fax:630-629-8318
Practice Address - Street 1:1919 MIDWEST RD
Practice Address - Street 2:SUITE 100
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1365
Practice Address - Country:US
Practice Address - Phone:630-629-8282
Practice Address - Fax:630-629-8318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036061620174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036061620Medicaid
ILC45802Medicare UPIN