Provider Demographics
NPI:1720276637
Name:DIONISIO B. YORRO, J.R.,M.D.,S.C.
Entity Type:Organization
Organization Name:DIONISIO B. YORRO, J.R.,M.D.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIONISIO
Authorized Official - Middle Name:
Authorized Official - Last Name:YORRO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:847-360-2368
Mailing Address - Street 1:68 AMBROGIO DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3339
Mailing Address - Country:US
Mailing Address - Phone:847-360-2368
Mailing Address - Fax:847-360-9872
Practice Address - Street 1:68 AMBROGIO DR
Practice Address - Street 2:SUITE 104
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3339
Practice Address - Country:US
Practice Address - Phone:847-360-2368
Practice Address - Fax:847-360-9872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-47148173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212715OtherMEDICARE GROUP NUMBER
IL036047148Medicaid
IL6189972349OtherMEDICARE NUMBER
IL036047148Medicaid
IL6189972349OtherMEDICARE NUMBER
ILK23455Medicare PIN