| Dr.vasanwala Llc | |
|
19 Heritage Dr Ste104 Bourbonnais IL 60914-1369 | |
| (815) 936-9440 | |
| Not Available |
| Full Name | Dr.vasanwala Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 19 Heritage Dr, Bourbonnais, Illinois |
| Authorized Official Name and Position | Salil R Vasanwala (DIRECTOR) |
| Authorized Official Contact | 8159369440 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr.vasanwala Llc 19 Heritage Dr Ste104 Bourbonnais IL 60914-1369 Ph: (815) 936-9440 | Dr.vasanwala Llc 19 Heritage Dr Ste104 Bourbonnais IL 60914-1369 Ph: (815) 936-9440 |
| NPI Number | 1457570061 |
|---|---|
| Provider Enumeration Date | 04/24/2007 |
| Last Update Date | 12/08/2009 |
| Medicare PECOS PAC ID | 6608975479 |
|---|---|
| Medicare Enrollment ID | O20070619000487 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457570061 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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