MEDICARE: DR. CHADI ISKANDAR YAACOUB 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	207L00000X	Anesthesiology Physician	4301082292	MI

General Provider Information

NPI Number	:	1760690028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHADI ISKANDAR YAACOUB M.D.

Provider Business Mailing Address
First Line	:	431 SUMMIT ST
Second Line	:
City	:	ELGIN
State	:	IL
Zip	:	60120-3861
Country	:	US
Telephone Number	:	224-535-7004
Fax Number	:	847-289-0815

Provider Business Practice Location Address
First Line	:	431 SUMMIT ST
Second Line	:
City	:	ELGIN
State	:	IL
Zip	:	60120-3861
Country	:	US
Telephone Number	:	224-535-7004
Fax Number	:	847-289-0815

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

Provider Enumeration Date	:	05/19/2007
Last Update Date	:	09/12/2012

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