Provider Demographics
NPI:1588650188
Name:YOUNG, JAMES ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALLEN
Last Name:YOUNG
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 1:850 S WABASH AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3642
Mailing Address - Country:US
Mailing Address - Phone:312-589-3527
Mailing Address - Fax:224-242-9002
Practice Address - Street 1:850 S WABASH AVE STE 210
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3642
Practice Address - Country:US
Practice Address - Phone:312-589-3527
Practice Address - Fax:224-242-9002
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-079462208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA37155Medicare UPIN
ILL99330Medicare ID - Type UnspecifiedLOCALITY 16