Individual
DR. PREECHA TAWJAREON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
815 W MAIN ST, SALEM, IL 62881-0875
(618) 548-2843
(618) 548-2896
Mailing address
815 W MAIN ST, PO BOX 875, SALEM, IL 62881-0875
(618) 548-2843
(618) 548-2896
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006115210
BLUECROSS BLUESHIELD
IL
01
—
CF1003
RAILROAD MEDICARE
IL
01
—
L06343
SALEM PIN #
IL
01
—
P04756
FLORA PIN #
IL
Enumeration date
03/04/2007
Last updated
02/19/2008
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