# PRASAN CHARIYASHOTILERT MD SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578618765
- **Authorized official:** PRASAN CHARIYA MD (PRESIDENT)
- **Authorized official phone:** (309) 779-5000

## Contact information

- **Practice address:** 2701 17TH ST, ROCK ISLAND, IL 61201-5351
- **Practice address phone:** (309) 779-5000
- **Mailing address:** PO BOX 689, LAKE FOREST, IL 60045-0689

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/25/2007
- **Last updated:** 10/29/2007