Provider Demographics
NPI:1508967597
Name:YAP, DENNIS D (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:D
Last Name:YAP
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 1:2979 LINDBERGH BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6556
Mailing Address - Country:US
Mailing Address - Phone:217-725-1422
Mailing Address - Fax:
Practice Address - Street 1:2979 LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6556
Practice Address - Country:US
Practice Address - Phone:217-679-2163
Practice Address - Fax:217-679-2174
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-087319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087319Medicaid
IL036087319Medicaid
K24324Medicare ID - Type Unspecified