Provider Demographics
NPI:1467608919
Name:YLITALO, ADAM WARREN (DO)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:WARREN
Last Name:YLITALO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 5839
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708
Mailing Address - Country:US
Mailing Address - Phone:254-202-4650
Mailing Address - Fax:254-202-4716
Practice Address - Street 1:50 HILLCREST MEDICAL BLVD.
Practice Address - Street 2:SUITE #208
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712
Practice Address - Country:US
Practice Address - Phone:254-202-7900
Practice Address - Fax:254-202-7999
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017834208800000X
TXP5499208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology