Provider Demographics
NPI:1477660751
Name:VICTORINO S YU, MD SC
Entity Type:Organization
Organization Name:VICTORINO S YU, MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORINO
Authorized Official - Middle Name:S
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-776-8308
Mailing Address - Street 1:3223 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-3333
Mailing Address - Country:US
Mailing Address - Phone:773-776-8308
Mailing Address - Fax:773-776-0891
Practice Address - Street 1:3223 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-3333
Practice Address - Country:US
Practice Address - Phone:773-776-8308
Practice Address - Fax:773-776-0891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036045414207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036045414Medicaid
IL036045414Medicaid
ILD12852Medicare UPIN
IL481010Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER