Provider Demographics
NPI:1508911942
Name:MICHAEL J YOUNG M D P C
Entity Type:Organization
Organization Name:MICHAEL J YOUNG M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-867-7430
Mailing Address - Street 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-789-2550
Mailing Address - Fax:
Practice Address - Street 1:711 W NORTH AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1174
Practice Address - Country:US
Practice Address - Phone:312-867-7430
Practice Address - Fax:312-867-7431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01622110OtherBCBS PROVIDER ID
IL476170OtherOLD MEDICARE-LOCALITY 16
IL631006OtherADVOCATE HLTH PARTNERS ID
ILDB5977OtherRAILROAD MEDICARE
IL476170OtherOLD MEDICARE-LOCALITY 16
IL=========00OtherADVOCATE HLTH CENTERS ID
IL631006OtherADVOCATE HLTH PARTNERS ID
ILDB5977Medicare PIN