MEDICARE: DR. EMRE N. YEDIDAG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD2005-0749	NM
2	208600000X	Surgery Physician	036.118805	IL

General Provider Information

NPI Number	:	1124051933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMRE N. YEDIDAG M.D.

Provider Business Mailing Address
First Line	:	2003 W FULTON ST STE 3
Second Line	:	C/O MR. SCOTT SCHNEIDER, PRESIDENT
City	:	CHICAGO
State	:	IL
Zip	:	60612-2365
Country	:	US
Telephone Number	:	773-292-4800
Fax Number	:	773-486-3548

Provider Business Practice Location Address
First Line	:	2003 W FULTON ST STE 3
Second Line	:	C/O MR. SCOTT SCHNEIDER, PRESIDENT
City	:	CHICAGO
State	:	IL
Zip	:	60612-2365
Country	:	US
Telephone Number	:	773-292-4800
Fax Number	:	773-486-3548

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	07/19/2007

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