# LEGACY PHYSIATRY GROUP ILLINOIS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Legacy Physiatry Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467830349
- **Authorized official:** VIVEK SASTRY DO (PRESIDENT/CEO)
- **Authorized official phone:** (972) 372-1663

## Contact information

- **Practice address:** 1603 ORRINGTON AVE, STE 600, EVANSTON, IL 60201-3841
- **Practice address phone:** (972) 372-1663
- **Practice address fax:** (972) 372-1657
- **Mailing address:** 850 CENTRAL PKWY E, SUITE 275, PLANO, TX 75074-5561
- **Mailing address phone:** (972) 372-1663
- **Mailing address fax:** (972) 372-1657

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 207RP1001X | Pulmonary Disease Physician | — | NULL | — |
| 207RP1001X | Pulmonary Disease Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 05/12/2015
- **Last updated:** 05/12/2015