Provider Demographics
NPI:1710993126
Name:YARKONY, GARY MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:MICHAEL
Last Name:YARKONY
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 1:1975 LIN LOR LN STE 195
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4920
Mailing Address - Country:US
Mailing Address - Phone:847-468-1511
Mailing Address - Fax:
Practice Address - Street 1:1975 LIN LOR LN
Practice Address - Street 2:SUITE 195
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4902
Practice Address - Country:US
Practice Address - Phone:847-468-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-058973208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058973Medicaid
ILIL3248001Medicare PIN
IL036058973Medicaid