Individual
DR. WATANACHAI SUJATANOND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 SOUTH 14TH STREET, HERRIN, IL 62948
(618) 942-4363
(618) 942-8573
Mailing address
POST OFFICE BOX 548, HERRIN, IL 62948
(618) 942-4363
(618) 942-8573
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10000129
BCBS
—
Enumeration date
10/24/2006
Last updated
07/08/2007
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