Healthcare Provider Details

I. General information

NPI: 1194974600
Provider Name (Legal Business Name): GAURAV YADAVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S YORK ST STE 4150
ELMHURST IL
60126-5630
US

IV. Provider business mailing address

1200 S YORK ST STE 4150
ELMHURST IL
60126-5630
US

V. Phone/Fax

Practice location:
  • Phone: 630-530-5577
  • Fax: 630-530-4477
Mailing address:
  • Phone: 630-530-5577
  • Fax: 630-530-4477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number20773
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number036121822
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: