Healthcare Provider Details

I. General information

NPI: 1902878358
Provider Name (Legal Business Name): EDWARD YAVITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 N ADDISON AVE
ELMHURST IL
60126-2821
US

IV. Provider business mailing address

100 W HIGGINS RD UNIT H35
SOUTH BARRINGTON IL
60010-9425
US

V. Phone/Fax

Practice location:
  • Phone: 630-833-9621
  • Fax:
Mailing address:
  • Phone: 630-793-4134
  • Fax: 630-833-9465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberS6064088
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: