MEDICARE: YIGAZU WELLNESS CLINIC S.C.

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1225432297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YIGAZU WELLNESS CLINIC S.C.

Provider Business Mailing Address
First Line	:	3660 N LAKE SHORE DR
Second Line	:	SUITE 3601
City	:	CHICAGO
State	:	IL
Zip	:	60613-5300
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2143 W WELLINGTON AVE
Second Line	:	SUITE 100
City	:	CHICAGO
State	:	IL
Zip	:	60618-8268
Country	:	US
Telephone Number	:	773-528-8400
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SOLOMON YIGAZU
Credential	:	M.D.
Telephone Number	:	773-528-5400

Provider Enumeration Date	:	10/20/2014
Last Update Date	:	01/28/2015

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