Provider Demographics
NPI:1174723761
Name:YANKE, JAMES R (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:YANKE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 BLANCHARD CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-2038
Mailing Address - Country:US
Mailing Address - Phone:630-682-0500
Mailing Address - Fax:630-682-1078
Practice Address - Street 1:7 BLANCHARD CIR STE 102
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-2038
Practice Address - Country:US
Practice Address - Phone:630-682-0500
Practice Address - Fax:630-682-1078
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085008769363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41942700Medicaid