National Provider Identifier Database

INTEGRAMED MEDICAL ILLINOIS LLC
Reproductive Endocrinology

An obstetrician/gynecologist who is capable of managing complex problems relating to reproductive endocrinology and infertility.


Contact Information

INTEGRAMED MEDICAL ILLINOIS, LLC
5401 N KNOXVILLE AVE
SUITE 102
PEORIA, IL61614-5098
Phone: 309-689-0411
Fax:
Website:
Specialty Taxonomy Code
* Reproductive Endocrinology 207VE0102X

* Indicates primary specialty

NPI Profile & details for INTEGRAMED MEDICAL ILLINOIS, LLC

NPI Number 1396169280
Legal business name
LBN
INTEGRAMED MEDICAL ILLINOIS, LLC
Authorized official SATISH VAYUVEGULA - (PRESIDEN AND SECRETARY)
Entity Organization
Organization subpart No
Enumeration date 02/12/2014
Last updated 02/24/2014 - About 12 years ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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