Provider Demographics
NPI:1225135825
Name:YU, CESAR G (MD)
Entity Type:Individual
Prefix:DR
First Name:CESAR
Middle Name:G
Last Name:YU
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 1:1007 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:618-244-7824
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:618-244-7824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-063758174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4100088OtherBLUE CROSS BLUE SHIELD
ID060006946OtherRAILROAD MEDICARE
ILD14819Medicare UPIN
IL682593Medicare ID - Type Unspecified