Provider Demographics
NPI:1861488892
Name:YOUNG, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 W WELLINGTON AVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4325
Mailing Address - Country:US
Mailing Address - Phone:773-281-1011
Mailing Address - Fax:773-281-1029
Practice Address - Street 1:1011 W WELLINGTON AVE
Practice Address - Street 2:STE. 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4325
Practice Address - Country:US
Practice Address - Phone:773-281-1011
Practice Address - Fax:773-281-1029
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036073765208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00661914OtherRAILROAD MEDICARE
IL036101015Medicaid
1635877OtherBCBS
K15688Medicare PIN
ILE78761Medicare UPIN