Individual
SURJIT THIARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
915 N CARON RD, ROCHELLE, IL 61068-9649
(815) 562-4014
Mailing address
PO BOX 418, ROCHELLE, IL 61068-0418
(815) 654-7772
(815) 654-7009
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
036073740
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036073740
—
IL
Enumeration date
01/17/2006
Last updated
07/16/2007
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