Provider Demographics
NPI:1134375488
Name:YARBROUGH, DEMETRIA L (MD)
Entity type:Individual
Prefix:DR
First Name:DEMETRIA
Middle Name:L
Last Name:YARBROUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:D
Other - Middle Name:L
Other - Last Name:YARBROUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:710 S PAULINA ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3808
Mailing Address - Country:US
Mailing Address - Phone:312-942-5440
Mailing Address - Fax:312-942-8961
Practice Address - Street 1:710 S PAULINA ST
Practice Address - Street 2:SUITE 601
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3808
Practice Address - Country:US
Practice Address - Phone:312-942-5440
Practice Address - Fax:312-942-8961
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101265517208M00000X
TN45197207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3042031Medicare PIN