Provider Demographics
NPI:1366636334
Name:YASIR A MEKKI MD SC
Entity Type:Organization
Organization Name:YASIR A MEKKI MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YASIR
Authorized Official - Middle Name:AKRAM
Authorized Official - Last Name:MEKKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-336-8472
Mailing Address - Street 1:222 S GREENLEAF ST
Mailing Address - Street 2:SUITE #112
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5705
Mailing Address - Country:US
Mailing Address - Phone:847-336-8472
Mailing Address - Fax:847-360-2229
Practice Address - Street 1:222 S GREENLEAF ST
Practice Address - Street 2:SUITE #112
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5705
Practice Address - Country:US
Practice Address - Phone:847-336-8472
Practice Address - Fax:847-360-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL474200Medicare PIN
ILG76841Medicare UPIN