MEDICARE: YELENA BOUMENDJEL, DPM, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1063159119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YELENA BOUMENDJEL, DPM, LLC

Provider Business Mailing Address
First Line	:	1025 W WISE RD STE 100
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60193-3746
Country	:	US
Telephone Number	:	224-653-2260
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 W WISE RD STE 100
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60193-3746
Country	:	US
Telephone Number	:	224-653-2260
Fax Number	:

Authorized Official
Title or Position	:	DPM
Name	:	YELENA BOUMENDJEL
Credential	:
Telephone Number	:	224-653-9287

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	05/18/2022

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