Provider Demographics
NPI:1245260629
Name:YU, LIYUAN (MD)
Entity type:Individual
Prefix:MS
First Name:LIYUAN
Middle Name:
Last Name:YU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 E BELVIDERE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2082
Mailing Address - Country:US
Mailing Address - Phone:847-918-1462
Mailing Address - Fax:847-968-4311
Practice Address - Street 1:1275 E BELVIDERE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2082
Practice Address - Country:US
Practice Address - Phone:847-918-1462
Practice Address - Fax:847-968-4311
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1156432085R0202X
PAMT047084T2085R0202X
NY2342822085R0202X
MA2162492085R0202X
OH35.0906122085R0202X
MI43011001912085R0202X
WI53945-202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036115643Medicaid
ILK33574Medicare PIN
ILK33575Medicare PIN
ILCH0689Medicare PIN
ILP00404654Medicare PIN
ILK33577Medicare PIN
ILI55907Medicare UPIN
ILK45892Medicare PIN
ILK33578Medicare PIN
ILK28961Medicare PIN
IL212545018Medicare PIN
ILK33573Medicare PIN
ILK33575Medicare PIN
ILP00404654Medicare PIN