Healthcare Provider Details

I. General information

NPI: 1376539221
Provider Name (Legal Business Name): SOLOMON M YIGAZU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7126 N LINCOLN AVE
LINCOLNWOOD IL
60712-2234
US

IV. Provider business mailing address

3660 N LAKE SHORE DR 1807
CHICAGO IL
60613-5300
US

V. Phone/Fax

Practice location:
  • Phone: 847-583-9189
  • Fax: 847-583-9196
Mailing address:
  • Phone: 312-560-1996
  • Fax: 312-247-2267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036109667
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: