MEDICARE: DEBRA E YOUNG DPM

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	213E00000X	Podiatrist	016-003073	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	208638	OTHER	IL	MEDICARE GROUP #
4	480034943	OTHER	IL	RAILROAD MEDICARE #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	4791120001	OTHER	IN	DMERC

General Provider Information

NPI Number	:	1689670051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA E YOUNG DPM

Provider Business Mailing Address
First Line	:	2752 N SOUTHPORT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1230
Country	:	US
Telephone Number	:	773-327-0006
Fax Number	:	773-295-2210

Provider Business Practice Location Address
First Line	:	2266 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-3718
Country	:	US
Telephone Number	:	773-871-3338
Fax Number	:	773-295-2210

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	06/09/2016

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Directions to “ DEBRA E YOUNG DPM” Practice Location

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