Healthcare Provider Details

I. General information

NPI: 1134375488
Provider Name (Legal Business Name): DEMETRIA L YARBROUGH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: D L YARBROUGH MD

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 S PAULINA ST SUITE 601
CHICAGO IL
60612-3808
US

IV. Provider business mailing address

710 S PAULINA ST SUITE 601
CHICAGO IL
60612-3808
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5440
  • Fax: 312-942-8961
Mailing address:
  • Phone: 312-942-5440
  • Fax: 312-942-8961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number45197
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101265517
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: