Healthcare Provider Details

I. General information

NPI: 1184698060
Provider Name (Legal Business Name): KATHARINE YAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. KATHY PERRY

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE NORTHSHORE UNIVERSITY HEALTH SYSTEM
EVANSTON IL
60201-1718
US

IV. Provider business mailing address

2650 RIDGE AVE. NORTHSHORE UNIVERSITY HEALTH SYSTEM
EVANSTON IL
60201-1718
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-1327
  • Fax: 847-733-3695
Mailing address:
  • Phone: 847-570-1327
  • Fax: 847-733-3695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number36095007
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: