Provider Demographics
NPI:1245245026
Name:SARAT YALAMANCHILI, MD, SC
Entity Type:Organization
Organization Name:SARAT YALAMANCHILI, MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAT
Authorized Official - Middle Name:
Authorized Official - Last Name:YALAMANCHILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-937-4500
Mailing Address - Street 1:1521 N CONVENT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1469
Mailing Address - Country:US
Mailing Address - Phone:815-937-4500
Mailing Address - Fax:815-937-4777
Practice Address - Street 1:1521 N CONVENT ST STE 101
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1469
Practice Address - Country:US
Practice Address - Phone:815-937-4500
Practice Address - Fax:815-937-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14D0960977OtherCLIA
IL4632101OtherBCBS
ILDP5055OtherRAILROAD MEDICARE
IL210129Medicare PIN