Healthcare Provider Details

I. General information

NPI: 1699262097
Provider Name (Legal Business Name): JONATHAN YIP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date: 11/28/2018
Reactivation Date: 12/05/2018

III. Provider practice location address

NORTHWESTERN MEMORIAL HOSPITAL 251 EAST HURON ST.
CHICAGO IL
60611
US

IV. Provider business mailing address

NORTHWESTERN MEMORIAL HOSPITAL 251 EAST HURON ST.
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-2000
  • Fax:
Mailing address:
  • Phone: 312-926-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036144503
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: