Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 036046328 | IL |
NPI | 1538156781 |
---|---|
Provider Name | Dr. Voraphot Sathissarat |
First Address | Joliet, IL 60435 |
Second Address | Joliet, IL 60435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 02/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036046328 | (05) | IL |
09932417 | BCBS (01) | |
C45403 | (02) |