Individual
DR. KEATTIYOAT WATTANAKIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5405 N KNOXVILLE AVE, PEORIA, IL 61614
(309) 691-4410
Mailing address
PO BOX 9382, PEORIA, IL 61612-9382
(309) 691-4410
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036126173
IL
207RC0000X
Cardiovascular Disease Physician
Primary
036126173
IL
207UN0901X
Nuclear Cardiology Physician
036126173
IL
2471C3401X
Computed Tomography Radiologic Technologist
—
—
Other
Enumeration date
02/17/2006
Last updated
04/28/2025
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