Provider Demographics
NPI:1982902342
Name:DR. DAVID B. YABLONSKY, D.O., P.C.
Entity Type:Organization
Organization Name:DR. DAVID B. YABLONSKY, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:YABLONSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:618-628-8211
Mailing Address - Street 1:2023 VADALABENE DR
Mailing Address - Street 2:SUITE 251
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-5630
Mailing Address - Country:US
Mailing Address - Phone:618-288-8850
Mailing Address - Fax:618-288-8943
Practice Address - Street 1:2023 VADALABENE DR
Practice Address - Street 2:SUITE 251
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5630
Practice Address - Country:US
Practice Address - Phone:618-288-8850
Practice Address - Fax:618-288-8943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115282207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty