Individual
SURASAK PRATUANGTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4440 W 95TH ST, OAK LAWN, IL 60453-2600
(708) 727-1267
Mailing address
8100 W 119TH ST STE 400, PALOS PARK, IL 60464-3080
(708) 361-3300
Taxonomy
Speciality
Code
Description
License number
State
2080P0208X
Pediatric Infectious Diseases Physician
Primary
036085443
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01626483
BCBS PROVIDER ID
IL
05
—
036085443
—
IL
05
—
200331500A
—
IN
01
—
25601
ADVOCATE HLTH PARTNERS ID
IL
Enumeration date
09/15/2005
Last updated
12/22/2021
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