Individual
MR. TEERA PITTAYATHIKHUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
211A SOUTH BURNS, SPARTA, IL 62286
(618) 443-3522
(618) 443-5036
Mailing address
211A SOUTH BURNS, SPARTA, IL 62286
(618) 443-3522
(618) 443-5036
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
36047341
IL
Other
Enumeration date
07/28/2006
Last updated
07/08/2007
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