Provider Demographics
NPI:1316181183
Name:RESURRECTION WESTLAKE HOSPITAL
Entity type:Organization
Organization Name:RESURRECTION WESTLAKE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:YELDANDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-938-7880
Mailing Address - Street 1:7311 W MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706-1157
Mailing Address - Country:US
Mailing Address - Phone:773-633-3665
Mailing Address - Fax:
Practice Address - Street 1:7311 W MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-1157
Practice Address - Country:US
Practice Address - Phone:773-633-3665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital