Provider Demographics
NPI:1801997192
Name:YANAGI, RUTH M (MD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:M
Last Name:YANAGI
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 1:122 S MICHIGAN AVE
Mailing Address - Street 2:SUITE 1317
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-6191
Mailing Address - Country:US
Mailing Address - Phone:312-663-5399
Mailing Address - Fax:312-922-5656
Practice Address - Street 1:122 S MICHIGAN AVE
Practice Address - Street 2:SUITE 1317
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-6191
Practice Address - Country:US
Practice Address - Phone:312-663-5399
Practice Address - Fax:312-922-5656
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2011-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360497412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036049741Medicaid
IL036049741OtherBLUE SHIELD
IL1627979OtherBLUE CROSS BLUE SHIELD
IL036049741Medicaid