Niranat Dejtiranukul
Otolaryngologist (ENT Doctor)
800 E Locust St
Olney
, Illinois 62450-2553
Niranat Dejtiranukul
Otolaryngologist (ENT Doctor)
800 E Locust St
Olney
, Illinois 62450-2553
(618) 395-7340
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About
Features
Specialties
- Otolaryngologist (ENT Doctor)
Languages spoken
- English
Location
First Address
- Niranat Dejtiranukul
- Po Box 97
- Olney, IL
- Zip : 62450-0097
- Phone : (618) 395-7340
Second Address
- Niranat Dejtiranukul
- 800 E Locust St
- Olney, IL
- Zip : 62450-2553
- Phone : (618) 395-7340
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 036-050750 | IL |
National Provider Identifier
| NPI | 1013049212 |
|---|---|
| Provider Name | Niranat Dejtiranukul |
| First Address | Olney, IL 62450-0097 |
| Second Address | Olney, IL 62450-2553 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 12/03/2007 |
| Last Update Date | 28/10/2011 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 036050750 | (05) | IL |
| 08022315 | BLUE CROSS/BLUE SHIELD (01) | IL |
| 216183 | MEDICARE PTAN (01) | |
| D86578 | (02) | IL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.