Healthcare Provider Details

I. General information

NPI: 1760581052
Provider Name (Legal Business Name): YARSHEN FAMILY MEDICINE SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24600 W. 127TH STREET UNITE 2 SUITE 125
PLAINFIELD IL
60585
US

IV. Provider business mailing address

24600 W. 127TH ST. UNITE 2, SUITE 125
PLAINFIIELD IL
60585
US

V. Phone/Fax

Practice location:
  • Phone: 815-577-0300
  • Fax: 815-577-0317
Mailing address:
  • Phone: 815-577-0300
  • Fax: 815-577-0317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARK J. YARSHEN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 815-577-0300