Healthcare Provider Details

I. General information

NPI: 1053723767
Provider Name (Legal Business Name): AKIRA YAMADA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

225 E CHICAGO AVE # 93 DIVISION OF PLASTIC SURGERY
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-4000
  • Fax: 312-227-9408
Mailing address:
  • Phone: 312-227-6258
  • Fax: 312-227-9408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number125064736
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: