MEDICARE: DR. YOGESH K AGARWAL MD

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	207R00000X	Internal Medicine Physician	036110034	IL
2	207RC0000X	Cardiovascular Disease Physician	036110034	IL
3	207RI0011X	Interventional Cardiology Physician	036110034	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036110034	OTHER	IL	ILLINOIS LICENSE

General Provider Information

NPI Number	:	1336142017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YOGESH K AGARWAL MD

Provider Business Mailing Address
First Line	:	1505 EASTLAND DR
Second Line	:	STE 330
City	:	BLOOMINGTON
State	:	IL
Zip	:	61701-3534
Country	:	US
Telephone Number	:	309-663-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 EASTLAND DR
Second Line	:	STE 330
City	:	BLOOMINGTON
State	:	IL
Zip	:	61701-3534
Country	:	US
Telephone Number	:	309-663-9800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	01/05/2024

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