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General NPI Number Information
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NPI Number | 1770905093
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Entity Type | Organization
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Legal Business Name | YALAMANCHILI OBGYN SC
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Dates
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Enumeration Date | 01/07/2014
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Last Update Date | 01/07/2014
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Provider Practice Location Address
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Address Line | 400 N WALL ST SUITE 403
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City | KANKAKEE
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State | IL
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Zip | 60901-2940
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Country | US
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Telephone | 815-933-2231
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Fax | 815-933-2297
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Provider Business Mailing Address
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Address Line | 400 N WALL ST SUITE 403
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City | KANKAKEE
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State | IL
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Zip | 60901-2940
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Country | US
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Telephone | 815-933-2231
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Fax | 815-933-2297
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAROJA YALAMANCHILI
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Credential | MD
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Telephone | 815-933-2231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 36094648
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License Number State | IL
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