=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629029061
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIO YU MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2006
-----------------------------------------------------
Last Update Date | 02/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1919 MIDWEST RD SUITE 100
-----------------------------------------------------
City | OAK BROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60523-1365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-629-8282
-----------------------------------------------------
Fax | 630-629-8318
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1919 MIDWEST RD STE 100
-----------------------------------------------------
City | OAK BROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60523-1365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-629-8282
-----------------------------------------------------
Fax | 630-629-8318
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 36061620
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------