Provider Demographics
NPI:1306897475
Name:DEMIDOVICH, YULIA M (MD)
Entity type:Individual
Prefix:DR
First Name:YULIA
Middle Name:M
Last Name:DEMIDOVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1740 W TAYLOR ST
Mailing Address - Street 2:3200W; MC 515
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7232
Mailing Address - Country:US
Mailing Address - Phone:312-996-4020
Mailing Address - Fax:312-996-4019
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:3200W; MC 515
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:312-996-4020
Practice Address - Fax:312-996-4019
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46973207L00000X
IL036109413207L00000X, 207LP3000X
WI46973-020207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
009906261OOtherHUMANA
WI1306897475Medicaid
WI34537900Medicaid
WI34537900Medicaid
WI1306897475Medicaid