Healthcare Provider Details

I. General information

NPI: 1689889354
Provider Name (Legal Business Name): ANDREW J YU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E CONGRESS PKWY STE 250
CRYSTAL LAKE IL
60014-6258
US

IV. Provider business mailing address

525 E CONGRESS PKWY STE 250
CRYSTAL LAKE IL
60014-6258
US

V. Phone/Fax

Practice location:
  • Phone: 847-658-6430
  • Fax: 847-658-6668
Mailing address:
  • Phone: 847-658-6430
  • Fax: 847-658-6668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036121630
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA90587
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35.129913
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number35.129913
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA90587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: