Illinois Laser & Vein Center, LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

ILLINOIS LASER & VEIN CENTER, LLC

Practice address

1521 N Convent St
Bourbonnais, IL 60914-1468

Phone

(815) 937-4500

Fax

(815) 937-4777

NPI assigned

Nov 14, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Sarat Yalamanchili, MD

Title

President

Phone

(815) 937-4500

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190678400000",
    "number": "1699847848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1521 N CONVENT ST",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609141468",
            "telephone_number": "815-937-4500",
            "fax_number": "815-937-4777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 N CONVENT ST",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609141468",
            "telephone_number": "815-937-4500",
            "fax_number": "815-937-4777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS LASER & VEIN CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2007-09-25",
        "status": "A",
        "authorized_official_last_name": "YALAMANCHILI",
        "authorized_official_first_name": "SARAT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-937-4500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Bourbonnais, IL
• Medical Specialty Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.