Provider Demographics
NPI:1255684635
Name:BOUMENDJEL, YELENA (DPM)
Entity Type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:BOUMENDJEL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 W WISE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-3746
Mailing Address - Country:US
Mailing Address - Phone:224-653-9287
Mailing Address - Fax:630-635-2260
Practice Address - Street 1:1025 W WISE RD STE 100
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-3746
Practice Address - Country:US
Practice Address - Phone:224-653-9287
Practice Address - Fax:630-635-2260
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005491213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine