Healthcare Provider Details

I. General information

NPI: 1275561409
Provider Name (Legal Business Name): SEIKO YAMADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 10/24/2022
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

150 HARVESTER DR SUITE 300
BURR RIDGE IL
60527-5919
US

V. Phone/Fax

Practice location:
  • Phone: 888-824-0200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number036100832
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: