Provider Demographics
NPI:1225432297
Name:YIGAZU WELLNESS CLINIC S.C.
Entity Type:Organization
Organization Name:YIGAZU WELLNESS CLINIC S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:
Authorized Official - Last Name:YIGAZU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-528-5400
Mailing Address - Street 1:3660 N LAKE SHORE DR
Mailing Address - Street 2:SUITE 3601
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-5300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2143 W WELLINGTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-8268
Practice Address - Country:US
Practice Address - Phone:773-528-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty