# ILLINOIS LASER & VEIN CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699847848
- **Authorized official:** DR. SARAT YALAMANCHILI MD (PRESIDENT)
- **Authorized official phone:** (815) 937-4500

## Contact information

- **Practice address:** 1521 N CONVENT ST, BOURBONNAIS, IL 60914-1468
- **Practice address phone:** (815) 937-4500
- **Practice address fax:** (815) 937-4777
- **Mailing address:** 1521 N CONVENT ST, BOURBONNAIS, IL 60914-1468
- **Mailing address phone:** (815) 937-4500
- **Mailing address fax:** (815) 937-4777

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/14/2006
- **Last updated:** 09/25/2007