Individual
DR. YANNIS N KOLETTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8921 N. WOOD SAGE RD., PEORIA, IL 61615-7822
(309) 243-2400
(309) 243-7918
Mailing address
8921 N. WOOD SAGE RD., PEORIA, IL 61615-7822
(309) 243-2400
(309) 243-7918
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036104432
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036104432
—
IL
Enumeration date
09/29/2005
Last updated
10/20/2021
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