Individual
VINISE ELACKATTU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
716 S MILWAUKEE AVE, LIBERTYVILLE, IL 60048-3225
(847) 362-1848
(847) 362-3351
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085009324
IL
363AS0400X
Surgical Physician Assistant
Primary
085009324
IL
Other
Enumeration date
09/08/2022
Last updated
04/22/2025
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