Organization
SURASAK AND SIRIMON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SURASAK PRATUANGTHAM M.D. (PRESIDENT)
(708) 218-6645
Entity
Organization
Contact information
Practice address
1222 LATHROP AVE, RIVER FOREST, IL 60305-1116
(708) 218-6645
Mailing address
1222 LATHROP AVE, RIVER FOREST, IL 60305-1116
(708) 218-6645
Taxonomy
Speciality
Code
Description
License number
State
2080P0208X
Pediatric Infectious Diseases Physician
Primary
036085443
IL
Other
Enumeration date
12/09/2014
Last updated
12/09/2014
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