Healthcare Provider Details

I. General information

NPI: 1710973763
Provider Name (Legal Business Name): ELIZABETH YERKES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 10/01/2019
Certification Date:
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
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 800-543-7362
  • Fax: 312-227-9412
Mailing address:
  • Phone: 800-543-7362
  • Fax: 312-227-9412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number036114299
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: