Healthcare Provider Details

I. General information

NPI: 1588743504
Provider Name (Legal Business Name): YSM MEDICAL GROUP CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4733 N DAMEN AVE
CHICAGO IL
60625-1442
US

IV. Provider business mailing address

653 N KINGSBURY ST
CHICAGO IL
60610-7069
US

V. Phone/Fax

Practice location:
  • Phone: 773-878-6060
  • Fax:
Mailing address:
  • Phone: 773-577-0147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CESAR A MORALES
Title or Position: INTERNAL MEDICINE
Credential: MD
Phone: 773-878-6060