Provider Demographics
NPI:1891547188
Name:YU, RICHIE O
Entity Type:Individual
Prefix:MR
First Name:RICHIE
Middle Name:O
Last Name:YU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 N OLCOTT AVE UNIT 609
Mailing Address - Street 2:
Mailing Address - City:HARWOOD HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60706-3562
Mailing Address - Country:US
Mailing Address - Phone:773-780-7656
Mailing Address - Fax:
Practice Address - Street 1:4811 N OLCOTT AVE UNIT 609
Practice Address - Street 2:
Practice Address - City:HARWOOD HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60706-3562
Practice Address - Country:US
Practice Address - Phone:773-780-7656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014885208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation