Provider Demographics
NPI:1285672840
Name:KATSNELSON, YAN (MD)
Entity Type:Individual
Prefix:DR
First Name:YAN
Middle Name:
Last Name:KATSNELSON
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:PO BOX 451
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-0451
Mailing Address - Country:US
Mailing Address - Phone:847-593-8460
Mailing Address - Fax:847-593-8604
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3311
Practice Address - Country:US
Practice Address - Phone:847-593-8460
Practice Address - Fax:847-593-8604
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105104208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105104Medicaid
IL036105104Medicaid