Provider Demographics
NPI:1831296540
Name:GAWO, YACOB H (MD)
Entity Type:Individual
Prefix:DR
First Name:YACOB
Middle Name:H
Last Name:GAWO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3800 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60624-2334
Mailing Address - Country:US
Mailing Address - Phone:773-826-6600
Mailing Address - Fax:773-826-1407
Practice Address - Street 1:3800 W MADISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-2334
Practice Address - Country:US
Practice Address - Phone:773-826-6600
Practice Address - Fax:773-826-1407
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2012-05-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036071593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036071593Medicaid
367830Medicare PIN
IL036071593Medicaid
ILC48880Medicare UPIN