Provider Demographics
NPI:1053723767
Name:YAMADA, AKIRA
Entity type:Individual
Prefix:
First Name:AKIRA
Middle Name:
Last Name:YAMADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E CHICAGO AVE # 93
Mailing Address - Street 2:DIVISION OF PLASTIC SURGERY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-6258
Mailing Address - Fax:312-227-9408
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:DIVISION OF PLASTIC SURGERY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-6258
Practice Address - Fax:312-227-9408
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125064736208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery