Provider Demographics
NPI:1588743504
Name:YSM MEDICAL GROUP CENTER
Entity type:Organization
Organization Name:YSM MEDICAL GROUP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-878-6060
Mailing Address - Street 1:653 N KINGSBURY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-7069
Mailing Address - Country:US
Mailing Address - Phone:773-577-0147
Mailing Address - Fax:
Practice Address - Street 1:4733 N DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1442
Practice Address - Country:US
Practice Address - Phone:773-878-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633361OtherBCBS PROVIDER
IL0360942361Medicaid
IL0360942361Medicaid
ILG93756Medicare UPIN