=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245245026
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SARAT YALAMANCHILI, MD, SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2006
-----------------------------------------------------
Last Update Date | 07/29/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1521 N CONVENT ST STE 101
-----------------------------------------------------
City | BOURBONNAIS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60914-1469
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-937-4500
-----------------------------------------------------
Fax | 815-937-4777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1521 N CONVENT ST STE 101
-----------------------------------------------------
City | BOURBONNAIS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60914-1469
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-937-4500
-----------------------------------------------------
Fax | 815-937-4777
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | SARAT YALAMANCHILI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 815-937-4500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------