Provider Demographics
NPI:1033120134
Name:YAP, ENRIQUE T (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:T
Last Name:YAP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5082 POPLAR LANE
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960
Mailing Address - Country:US
Mailing Address - Phone:618-524-9087
Mailing Address - Fax:618-524-9500
Practice Address - Street 1:5082 POPLAR LANE
Practice Address - Street 2:
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960
Practice Address - Country:US
Practice Address - Phone:618-524-9050
Practice Address - Fax:618-524-9500
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D10769Medicare UPIN
298470Medicare ID - Type Unspecified