Provider Demographics
NPI:1245356542
Name:WESTLAKE HOSPITAL
Entity type:Organization
Organization Name:WESTLAKE HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:V
Authorized Official - Last Name:YELDANDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-938-7350
Mailing Address - Street 1:1111 SUPERIOR ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-4100
Mailing Address - Country:US
Mailing Address - Phone:708-344-2161
Mailing Address - Fax:708-344-3156
Practice Address - Street 1:1111 SUPERIOR ST STE 101
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4100
Practice Address - Country:US
Practice Address - Phone:708-344-2161
Practice Address - Fax:708-344-3156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036069861Medicaid
1623610OtherBLUE CROSS BLUE SHIELD
IL568750Medicare PIN