Healthcare Provider Details

I. General information

NPI: 1356442784
Provider Name (Legal Business Name): VIJAYALAKSHMI YALAMANCHILI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 E WHITESTONE BLVD SPC 100
CEDAR PARK TX
78613-7598
US

IV. Provider business mailing address

125 S CLARK ST STE 900
CHICAGO IL
60603-4043
US

V. Phone/Fax

Practice location:
  • Phone: 512-988-5355
  • Fax: 512-323-0307
Mailing address:
  • Phone: 512-988-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG7908
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: