Provider Demographics
NPI:1912046020
Name:YVON NAZON MD SC
Entity Type:Organization
Organization Name:YVON NAZON MD SC
Other - Org Name:NAZON MEDICAL CORPORATION AND WELLNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:YVON
Authorized Official - Middle Name:JEUNE
Authorized Official - Last Name:NAZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-734-7551
Mailing Address - Street 1:6111 HARRISON ST
Mailing Address - Street 2:STE 308
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-2969
Mailing Address - Country:US
Mailing Address - Phone:773-734-7551
Mailing Address - Fax:708-585-0211
Practice Address - Street 1:6111 HARRISON ST
Practice Address - Street 2:STE 308
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2969
Practice Address - Country:US
Practice Address - Phone:773-734-7551
Practice Address - Fax:708-585-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01021678C207V00000X
IN01021678207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100438330Medicaid
IL19404Medicare PIN
IN100438330Medicaid
IN877100Medicare PIN
IL465690Medicare PIN
ILB29032Medicare UPIN