Provider Demographics
NPI:1255331658
Name:YALAVARTHI, SULOCHANA D (MD)
Entity Type:Individual
Prefix:DR
First Name:SULOCHANA
Middle Name:D
Last Name:YALAVARTHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4647 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2319
Mailing Address - Country:US
Mailing Address - Phone:708-747-5850
Mailing Address - Fax:708-747-9991
Practice Address - Street 1:1 INGALLS DR
Practice Address - Street 2:CANCER CARE CENTER
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-3558
Practice Address - Country:US
Practice Address - Phone:708-915-6620
Practice Address - Fax:708-915-3782
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360611792085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036061179Medicaid
ILDE9375Medicare PIN
ILC43592Medicare UPIN
IL036061179Medicaid
IL759800Medicare PIN
IL920000418Medicare PIN