Basic Information
| Provider Information | |||||||||
| NPI: | 1508911942 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHAEL J YOUNG M D P C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 OAKMONT LN | ||||||||
| Address2: | SUITE 1600 | ||||||||
| City: | WESTMONT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605595511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307892550 | ||||||||
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| Practice Location | |||||||||
| Address1: | 711 W NORTH AVE | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606101174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3128677430 | ||||||||
| FaxNumber: | 3128677431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | YOUNG | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3128677430 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 01622110 | 01 | IL | BCBS PROVIDER ID | OTHER | 476170 | 01 | IL | OLD MEDICARE-LOCALITY 16 | OTHER | 631006 | 01 | IL | ADVOCATE HLTH PARTNERS ID | OTHER | DB5977 | 01 | IL | RAILROAD MEDICARE | OTHER |