Organization · NPI-2

Dr.Vasanwala LLC

Internal Medicine · Bourbonnais, IL

NPI number1457570061
StatusActive
Last updated in NPPESDec 8, 2009

Details

NPI
1457570061
Entity type
Organization (NPI-2)
Legal business name
Dr.Vasanwala LLC
Organization subpart
No
Enumeration date
Apr 24, 2007
Last updated
Dec 8, 2009

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal Medicine––Yes

Practice location

19 Heritage Dr
Ste104
Bourbonnais, IL 60914-1369

Phone 815-936-9440

Mailing address

19 Heritage Dr
Ste104
Bourbonnais, IL 60914-1369

Phone 815-936-9440

Authorized official

Salil R Vasanwala
Director
8159369440

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