Provider Demographics
NPI:1235546516
Name:UY, REUEL YOUNG (MD)
Entity Type:Individual
Prefix:
First Name:REUEL
Middle Name:YOUNG
Last Name:UY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:REUEL
Other - Middle Name:C
Other - Last Name:YOUNG UY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2022 KELLE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-8708
Mailing Address - Country:US
Mailing Address - Phone:219-364-3616
Mailing Address - Fax:192-364-3610
Practice Address - Street 1:3630 WILLOWCREEK RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-5075
Practice Address - Country:US
Practice Address - Phone:219-364-3616
Practice Address - Fax:216-364-3610
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.064349207R00000X
IN01078242A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine