Individual
DR. SIRISAK SUNTHARASANTIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4 MEMORIAL DR STE 210, ALTON, IL 62002-6751
(618) 463-0649
(618) 463-3390
Mailing address
4 MEMORIAL DR STE 210, ALTON, IL 62002-6751
(618) 463-0649
(618) 463-3390
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036048367
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036048367
—
IL
Enumeration date
12/28/2006
Last updated
05/03/2018
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