Individual
KIRAN KUMAR YELAKANTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2512 HURST DR STE 130, MATTOON, IL 61938-9200
(217) 258-7590
(217) 258-3686
Mailing address
611 W PARK ST, FAPC, URBANA, IL 61801
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036153492
IL
208000000X
Pediatrics Physician
276624
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03924081
—
NY
05
—
0560481
—
NJ
05
—
300018617
—
IN
Enumeration date
10/18/2011
Last updated
08/20/2020
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