Healthcare Provider Details

I. General information

NPI: 1912909615
Provider Name (Legal Business Name): YAKOV RYABOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N WOLF RD
WHEELING IL
60090-3027
US

IV. Provider business mailing address

3230 HIGHLAND RD
NORTHBROOK IL
60062-6905
US

V. Phone/Fax

Practice location:
  • Phone: 847-419-1900
  • Fax: 847-419-1964
Mailing address:
  • Phone: 847-419-1900
  • Fax: 847-419-1964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036089785
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: