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Individual

DHANASARN MONGKOLSMAI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2206 BERRYWOOD LN, BLOOMINGTON, IL 61704-2448
(309) 662-2032
Mailing address
2206 BERRYWOOD LN, BLOOMINGTON, IL 61704-2448
(309) 662-2032

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036059806
IL
207RC0000X
Cardiovascular Disease Physician
Primary
036059806
IL

Other

Enumeration date
10/04/2011
Last updated
10/04/2011
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