Organization
PRIMARY CARE SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SRIVALLI VEGI M.D. (OWNER)
(636) 579-6778
Entity
Organization
Contact information
Practice address
2 AIRLINE DR, SUITE 500, BLOOMINGTON, IL 61704-3433
(636) 579-6778
Mailing address
2 AIRLINE DR, SUITE 500, BLOOMINGTON, IL 61704-3433
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036121501
IL
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
036121501
IL
Other
Enumeration date
05/25/2009
Last updated
04/15/2010
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