Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | IL |
NPI | 1487788006 |
---|---|
Provider Name | Chiravudh Sawetawan |
First Address | Rockford, IL 61107-5912 |
Second Address | Rockford, IL 61107-5912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F62184 | (02) | IL |