Provider Demographics
NPI:1124077326
Name:YALAMANCHILI, SAROJA (MD)
Entity type:Individual
Prefix:DR
First Name:SAROJA
Middle Name:
Last Name:YALAMANCHILI
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 1:338 LARRY POWER RD
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-4430
Mailing Address - Country:US
Mailing Address - Phone:815-935-4651
Mailing Address - Fax:815-935-2970
Practice Address - Street 1:338 LARRY POWER RD
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-4430
Practice Address - Country:US
Practice Address - Phone:815-935-2970
Practice Address - Fax:815-935-2279
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-094648207V00000X
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-094648Medicaid