Provider Demographics
NPI:1093760415
Name:YEGELWEL, ERIC J (MD)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:J
Last Name:YEGELWEL
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 1:3405 N ARLINGTON HEIGHTS ROAD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004
Mailing Address - Country:US
Mailing Address - Phone:847-577-9300
Mailing Address - Fax:847-577-9318
Practice Address - Street 1:3405 N ARLINGTON HEIGHTS ROAD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004
Practice Address - Country:US
Practice Address - Phone:847-577-9300
Practice Address - Fax:847-577-9318
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.069591207R00000X, 207RG0100X
IL036069591207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036069591Medicaid
ILE18443Medicare UPIN
IL036069591Medicaid