Healthcare Provider Details

I. General information

NPI: 1225432297
Provider Name (Legal Business Name): YIGAZU WELLNESS CLINIC S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2143 W WELLINGTON AVE SUITE 100
CHICAGO IL
60618-8268
US

IV. Provider business mailing address

3660 N LAKE SHORE DR SUITE 3601
CHICAGO IL
60613-5300
US

V. Phone/Fax

Practice location:
  • Phone: 773-528-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SOLOMON YIGAZU
Title or Position: OWNER
Credential: M.D.
Phone: 773-528-5400