Provider Demographics
NPI:1538305867
Name:MADHURI R YEMUL M D S C
Entity Type:Organization
Organization Name:MADHURI R YEMUL M D S C
Other - Org Name:PRIMARY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SADNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-375-6500
Mailing Address - Street 1:PO BOX 9336
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60567-0336
Mailing Address - Country:US
Mailing Address - Phone:630-904-4949
Mailing Address - Fax:630-904-4959
Practice Address - Street 1:24024 BRANCASTER DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8044
Practice Address - Country:US
Practice Address - Phone:630-904-4949
Practice Address - Fax:630-904-4959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101657207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1533Medicare PIN