Provider Demographics
NPI:1740642628
Name:KPR ENDOCRINOLOGY LLC
Entity type:Organization
Organization Name:KPR ENDOCRINOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SUDHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:YALAMANCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-487-3736
Mailing Address - Street 1:20 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2829
Mailing Address - Country:US
Mailing Address - Phone:630-487-3736
Mailing Address - Fax:630-487-3738
Practice Address - Street 1:621 PLAINFIELD RD
Practice Address - Street 2:ST 107
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5343
Practice Address - Country:US
Practice Address - Phone:708-446-7527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121291207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty