Individual
DR. POONPUTT CHOTIPRASIDHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
525 VALLEY VIEW DR, MOLINE, IL 61265-6138
(309) 601-2800
(309) 601-2801
Mailing address
525 VALLEY VIEW DR, MOLINE, IL 61265-6138
(309) 601-2800
(309) 601-2801
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036103123
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036103123
—
IL
01
—
P00155422
RAILROAD MEDICARE
IL
Enumeration date
06/01/2005
Last updated
04/24/2019
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