Healthcare Provider Details

I. General information

NPI: 1508967597
Provider Name (Legal Business Name): DENNIS D. YAP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2979 LINDBERGH BLVD
SPRINGFIELD IL
62704-6556
US

IV. Provider business mailing address

2979 LINDBERGH BLVD
SPRINGFIELD IL
62704-6556
US

V. Phone/Fax

Practice location:
  • Phone: 217-679-2163
  • Fax: 217-679-2174
Mailing address:
  • Phone: 217-725-1422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-087319
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: