Healthcare Provider Details

I. General information

NPI: 1295039865
Provider Name (Legal Business Name): CEMAL YAZICI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S WOOD STREET SUITE 718E
CHICAGO IL
60612
US

IV. Provider business mailing address

840 S WOOD ST SUITE 718E
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7000
  • Fax:
Mailing address:
  • Phone: 312-996-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036.128567
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: