Basic Information
| Provider Information | |||||||||
| NPI: | 1982902342 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DR. DAVID B. YABLONSKY, D.O., P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2023 VADALABENE DR | ||||||||
| Address2: | SUITE 251 | ||||||||
| City: | MARYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620625630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182888850 | ||||||||
| FaxNumber: | 6182888943 | ||||||||
| Practice Location | |||||||||
| Address1: | 2023 VADALABENE DR | ||||||||
| Address2: | SUITE 251 | ||||||||
| City: | MARYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620625630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182888850 | ||||||||
| FaxNumber: | 6182888943 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2011 | ||||||||
| LastUpdateDate: | 12/08/2015 | ||||||||
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| AuthorizedOfficialLastName: | YABLONSKY | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | B. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER / PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 6186288211 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036115282 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | 036115282 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.