Provider Demographics
NPI:1356337380
Name:YAKOUB, NANAJAN (MD)
Entity type:Individual
Prefix:
First Name:NANAJAN
Middle Name:
Last Name:YAKOUB
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 1:350 S NORTHWEST HWY STE 302
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4262
Mailing Address - Country:US
Mailing Address - Phone:847-457-4000
Mailing Address - Fax:773-907-0982
Practice Address - Street 1:2740 W FOSTER AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3500
Practice Address - Country:US
Practice Address - Phone:773-907-0978
Practice Address - Fax:773-907-0982
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0924001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092400Medicaid
IL01632852OtherBCBS PROVIDER ID
ILK13378Medicare PIN