Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 036129012 | IL |
N | 207RC0000X | Internist - Cardiovascular Disease | 036129012 | IL |
NPI | 1881707248 |
---|---|
Provider Name | Dr. Clyde Warren Yancy JR. |
First Address | Chicago, IL 60611-2981 |
Second Address | Chicago, IL 60611-5969 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 13/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8W0061 | BCBS (01) | TX |
C23831 | (02) | TX |