Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 036093897 | IL |
NPI | 1174504880 |
---|---|
Provider Name | Mr. Sunthorn Muangmingsuk |
First Address | Willow Brook, IL 60527-5343 |
Second Address | Oak Lawn, IL 60453-2600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 17/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036093897 | (05) | IL |
200445700 | (05) | IN |
H91107 | (02) |