Provider Demographics
NPI:1831474279
Name:SUTRAVE, YOGESH G (RSA)
Entity Type:Individual
Prefix:MR
First Name:YOGESH
Middle Name:G
Last Name:SUTRAVE
Suffix:
Gender:M
Credentials:RSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6743 S POINTE DR UNIT 3C
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-6291
Mailing Address - Country:US
Mailing Address - Phone:920-378-9266
Mailing Address - Fax:
Practice Address - Street 1:6743 S POINTE DR UNIT 3C
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-6291
Practice Address - Country:US
Practice Address - Phone:920-378-9266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000299363AS0400X, 246ZC0007X, 246ZS0410X
246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist