Provider Demographics
NPI:1194722942
Name:YALAMANCHILI, SARAT (MD)
Entity type:Individual
Prefix:DR
First Name:SARAT
Middle Name:
Last Name:YALAMANCHILI
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 1:1521 N CONVENT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1469
Mailing Address - Country:US
Mailing Address - Phone:815-937-4500
Mailing Address - Fax:815-937-4777
Practice Address - Street 1:1521 N CONVENT ST STE 101
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1469
Practice Address - Country:US
Practice Address - Phone:815-937-4500
Practice Address - Fax:815-937-4777
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2021-03-16
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
IL036-094568207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00763066OtherRAILROAD MEDICARE
IL4632101OtherBCBS
IL036094568Medicaid
G16140Medicare UPIN
IL036094568Medicaid