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NPI Code Detail

MEDICARE: DR. CLYDE WARREN YANCY JR. M.D.

MEDICARE: DR. CLYDE WARREN YANCY JR. M.D.
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
1207RC0000XCardiovascular Disease Physician036129012IL
2207RA0001XAdvanced Heart Failure and Transplant Cardiology Physician036129012IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18W0061OTHERTXBCBS

General Provider Information

NPI Number : 1881707248
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CLYDE WARREN YANCY JR. M.D.
Provider Business Mailing Address
First Line : 676 N SAINT CLAIR ST STE 600
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2981
Country : US
Telephone Number : 312-695-0829
Fax Number : 312-695-5774
Provider Business Practice Location Address
First Line : 675 N SAINT CLAIR ST STE 19-100
Second Line :
City : CHICAGO
State : IL
Zip : 60611-5969
Country : US
Telephone Number : 312-664-3278
Fax Number : 312-695-5774
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2006
Last Update Date : 02/13/2020

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