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Individual

RANDALL SCOTT YESSENOW

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
60 E DELAWARE PL STE 1400, CHICAGO, IL 60611-1806
(312) 202-9909
Mailing address
PO BOX 405, SCHERERVILLE, IN 46375-0405
(219) 742-0990

Taxonomy

Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
01039206
IN
208200000X
Plastic Surgery Physician
Primary
036.086614
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1859137007
CIGNA PROVIDER NO.
IN
01
4411395
AETNA PROVIDER NO.
IN
01
88688
ANTHEM PROVIDER NO.
IN
01
911-08053
BC/BS OF IL PROVIDER NO.
IN
01
942359
UNITED HEALTHCARE NO.
IN
Enumeration date
03/27/2006
Last updated
01/23/2024
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