Provider Demographics
NPI:1104812486
Name:YELDANDI, VIJAY (MD)
Entity type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:
Last Name:YELDANDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SUPERIOR ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-4055
Mailing Address - Country:US
Mailing Address - Phone:773-205-4661
Mailing Address - Fax:708-938-7098
Practice Address - Street 1:1200 SUPERIOR ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4055
Practice Address - Country:US
Practice Address - Phone:773-205-4661
Practice Address - Fax:708-938-7098
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-069861207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-069-861Medicaid
ILL87891Medicare PIN
IL036-069-861Medicaid
ILL87890Medicare PIN
ILC41465Medicare UPIN
ILL88204Medicare PIN