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NPI Code Detail

MEDICARE: MARTHA YANEZ M.D.

MEDICARE:   MARTHA  YANEZ  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
1208000000XPediatrics Physician036088167IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101621679OTHERILBCBS OF IL

General Provider Information

NPI Number : 1255317533
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA YANEZ M.D.
Provider Business Mailing Address
First Line : 2525 S MICHIGAN AVE
Second Line : MEDICAL STAFF OFFICE
City : CHICAGO
State : IL
Zip : 60616-2477
Country : US
Telephone Number : 312-567-5677
Fax Number : 312-567-6189
Provider Business Practice Location Address
First Line : 5525 S PULASKI RD
Second Line :
City : CHICAGO
State : IL
Zip : 60629-4400
Country : US
Telephone Number : 312-567-7500
Fax Number : 312-447-7740
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2005
Last Update Date : 04/05/2018

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