Individual
DAVID C. NARUNATVANICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 KISH HOSPITAL DR, DEKALB, IL 60115-9602
(815) 756-1521
Mailing address
680 N LAKE SHORE DR STE 1000, CHICAGO, IL 60611-8709
(312) 695-9494
(312) 695-6594
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036-116278
IL
207P00000X
Emergency Medicine Physician
036.116278
IL
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
036116278
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036116278
STATE LICENSE
IL
05
—
036116278
—
IL
01
—
1790896439
BLUE SHIELD
IL
Enumeration date
08/31/2006
Last updated
11/20/2019
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