Provider Demographics
NPI:1184635476
Name:YU, EVELYN B (MD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:B
Last Name:YU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 S 42ND ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6217
Mailing Address - Country:US
Mailing Address - Phone:618-244-7493
Mailing Address - Fax:
Practice Address - Street 1:1007 S 42ND ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6217
Practice Address - Country:US
Practice Address - Phone:618-244-7493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL410087OtherBLUE CROSS BLUE SHIELD
IL410087OtherBLUE CROSS BLUE SHIELD
IL756650Medicare ID - Type Unspecified