Provider Demographics
NPI:1932517711
Name:YURAMED LLC
Entity Type:Organization
Organization Name:YURAMED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:YURIY
Authorized Official - Middle Name:
Authorized Official - Last Name:ILKOVYCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-305-8206
Mailing Address - Street 1:242 REGINA ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-2315
Mailing Address - Country:US
Mailing Address - Phone:215-856-7409
Mailing Address - Fax:
Practice Address - Street 1:826 BUSTLETON PIKE
Practice Address - Street 2:UNIT 101A
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6064
Practice Address - Country:US
Practice Address - Phone:215-305-8206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA369171Medicare PIN