Individual
DR. YUKHOL LERTSBURAPA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2222 W DIVISION ST, SUITE 260, CHICAGO, IL 60622-2717
(773) 486-3535
(630) 983-8803
Mailing address
PO BOX 8043, WOODRIDGE, IL 60517-8043
(773) 486-3535
(630) 983-8803
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31600582
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/23/2005
Last updated
07/08/2007
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