Provider Demographics
NPI:1356520795
Name:RONALD F YAKE MD SC
Entity type:Organization
Organization Name:RONALD F YAKE MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:YAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-395-1991
Mailing Address - Street 1:1021 N MULFORD RD
Mailing Address - Street 2:SUITE L3
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107
Mailing Address - Country:US
Mailing Address - Phone:815-395-1991
Mailing Address - Fax:815-395-1994
Practice Address - Street 1:1021 N MULFORD RD
Practice Address - Street 2:SUITE L3
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107
Practice Address - Country:US
Practice Address - Phone:815-395-1991
Practice Address - Fax:815-395-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC38389Medicare UPIN
IL254790Medicare PIN