Healthcare Provider Details

I. General information

NPI: 1184073702
Provider Name (Legal Business Name): MENGDI YAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2016
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8505 183RD ST STE A
TINLEY PARK IL
60487-9354
US

IV. Provider business mailing address

8505 183RD ST STE A
TINLEY PARK IL
60487-9354
US

V. Phone/Fax

Practice location:
  • Phone: 815-824-4406
  • Fax:
Mailing address:
  • Phone: 815-824-4406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number266920
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number036170094
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: