Individual
GUNTIPPAR S PRATUMNGERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
7255 N CALDWELL AVE, NILES, IL 60714-4501
(847) 647-0355
(847) 647-7638
Mailing address
7255 N CALDWELL AVE, NILES, IL 60714-4501
(847) 647-0355
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-105741
IL
2083X0100X
Occupational Medicine Physician
336066466
IL
Other
Enumeration date
04/03/2007
Last updated
01/14/2019
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