Provider Demographics
NPI:1760690028
Name:YAACOUB, CHADI ISKANDAR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHADI
Middle Name:ISKANDAR
Last Name:YAACOUB
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 1:431 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-3861
Mailing Address - Country:US
Mailing Address - Phone:224-535-7004
Mailing Address - Fax:847-289-0815
Practice Address - Street 1:431 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-3861
Practice Address - Country:US
Practice Address - Phone:224-535-7004
Practice Address - Fax:847-289-0815
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082292207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology