Individual
DR. THANOM TEMIYASATHIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1302 FRANKLIN AVE, SUITE 4500, NORMAL, IL 61761-3551
(309) 828-1166
(309) 862-0330
Mailing address
1302 FRANKLIN AVE, SUITE 4500, NORMAL, IL 61761-3551
(309) 828-1166
(309) 862-0330
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036-054080
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008003
HEALTH ALLIANCE
IL
05
—
036054080
—
IL
01
—
05732097
BC GROUP NUMBER
IL
Enumeration date
07/09/2006
Last updated
07/08/2007
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