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General NPI Number Information
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NPI Number | 1356337380
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Entity Type | Individual
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Provider Name | NANAJAN YAKOUB MD
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Gender | Female
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 03/15/2019
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Provider Practice Location Address
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Address Line | 2740 W FOSTER AVE SUITE 410
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City | CHICAGO
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State | IL
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Zip | 60625-3500
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Country | US
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Telephone | 773-907-0978
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Fax | 773-907-0982
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Provider Business Mailing Address
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Address Line | 350 S NORTHWEST HWY STE 302
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City | PARK RIDGE
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State | IL
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Zip | 60068-4262
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Country | US
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Telephone | 847-457-4000
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Fax | 773-907-0982
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036-0924001
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License Number State | IL
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