Provider Demographics
NPI:1558440404
Name:SHKLYAR, YURY M (MD)
Entity Type:Individual
Prefix:DR
First Name:YURY
Middle Name:M
Last Name:SHKLYAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 W WINCHESTER RD
Mailing Address - Street 2:SUITE 144
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5358
Mailing Address - Country:US
Mailing Address - Phone:847-680-1200
Mailing Address - Fax:847-680-1211
Practice Address - Street 1:1870 W WINCHESTER RD
Practice Address - Street 2:SUITE 144
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5358
Practice Address - Country:US
Practice Address - Phone:847-680-1200
Practice Address - Fax:847-680-1211
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036090663207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036090663Medicaid
IL036090663Medicaid
ILF63577Medicare UPIN