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General NPI Number Information
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NPI Number | 1780827659
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Entity Type | Individual
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Provider Name | TRAVIS TAKANORI YAMANAKA MD
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Gender | Male
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Dates
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Enumeration Date | 04/08/2009
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 2525 S MICHIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60616-2315
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Country | US
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Telephone | 312-567-7616
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Fax | 312-567-6682
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Provider Business Mailing Address
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Address Line | 5044 N SAWYER AVE # 3
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City | CHICAGO
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State | IL
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Zip | 60625-4910
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Country | US
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Telephone | 612-716-1192
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036128998
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 036128998
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 036128998
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License Number State | IL
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