Provider Demographics
NPI:1689670051
Name:YOUNG, DEBRA E (DPM)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:E
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2752 N SOUTHPORT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1230
Mailing Address - Country:US
Mailing Address - Phone:773-327-0006
Mailing Address - Fax:773-295-2210
Practice Address - Street 1:2266 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3718
Practice Address - Country:US
Practice Address - Phone:773-871-3338
Practice Address - Fax:773-295-2210
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-003073213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208638OtherMEDICARE GROUP #
IL03-0403187Medicaid
IN200844930AMedicaid
IL480034943OtherRAILROAD MEDICARE #
IN4791120001OtherDMERC
IN200844930AMedicaid
ILT37487Medicare UPIN
ILK50334Medicare PIN
ILK18705Medicare PIN
WI864760019Medicare PIN
IN859800UMedicare PIN
IL480034943OtherRAILROAD MEDICARE #
IL03-0403187Medicaid
ILK18706Medicare PIN
ILK18708Medicare PIN
WI864990014Medicare PIN
ILK18707Medicare UPIN
IN253530Medicare PIN
WI001486486Medicare PIN