Provider Demographics
NPI:1629029061
Name:YU, MARIO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:
Last Name:YU
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 1:1919 MIDWEST RD
Mailing Address - Street 2:STE 100
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1365
Mailing Address - Country:US
Mailing Address - Phone:630-629-8282
Mailing Address - Fax:630-629-8318
Practice Address - Street 1:1919 MIDWEST RD
Practice Address - Street 2:SUITE 100
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1365
Practice Address - Country:US
Practice Address - Phone:630-629-8282
Practice Address - Fax:630-629-8318
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36061620207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL700851OtherMEDICARE PROVIDER
IL700851OtherMEDICARE PROVIDER
ILC45802Medicare UPIN