MEDICARE: EDWARD YAVITZ MD

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	207W00000X	Ophthalmology Physician	S6064088	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036064088	OTHER	IL	ILLINOIS STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902878358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD YAVITZ MD

Provider Business Mailing Address
First Line	:	100 W HIGGINS RD UNIT H35
Second Line	:
City	:	SOUTH BARRINGTON
State	:	IL
Zip	:	60010-9425
Country	:	US
Telephone Number	:	630-833-9621
Fax Number	:	630-833-9465

Provider Business Practice Location Address
First Line	:	152 N ADDISON AVE
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-2821
Country	:	US
Telephone Number	:	630-833-9621
Fax Number	:

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	06/23/2026

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