Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 036-045186 | IL |
NPI | 1073624375 |
---|---|
Provider Name | Mr. Chaiyapon Couropmitree |
First Address | Riverside, IL 60546-2604 |
Second Address | Riverside, IL 60546-2604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-045186 | STATE LICENSE NUMBER (01) | IL |
C41856 | (02) | IL |