Surasak Pratuangtham
Pediatric Infectious Diseases
4440 W 95th St
Oak Lawn
, Illinois 60453-2600
Surasak Pratuangtham
Pediatric Infectious Diseases
4440 W 95th St
Oak Lawn
, Illinois 60453-2600
(708) 361-3300
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About
Features
Specialties
- Pediatric Infectious Diseases
Languages spoken
- English
Location
First Address
- Surasak Pratuangtham
- 8100 W 119th St Ste 400
- Palos Park, IL
- Zip : 60464-3080
- Phone : (708) 361-3300
Second Address
- Surasak Pratuangtham
- 4440 W 95th St
- Oak Lawn, IL
- Zip : 60453-2600
- Phone : (708) 727-1267
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2080P0208X | Pediatric Infectious Diseases | 036085443 | IL |
National Provider Identifier
| NPI | 1639164601 |
|---|---|
| Provider Name | Surasak Pratuangtham |
| First Address | Palos Park, IL 60464-3080 |
| Second Address | Oak Lawn, IL 60453-2600 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 15/09/2005 |
| Last Update Date | 22/12/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 01626483 | BCBS PROVIDER ID (01) | IL |
| 036085443 | (05) | IL |
| 200331500A | (05) | IN |
| 25601 | ADVOCATE HLTH PARTNERS ID (01) | IL |
| F59850 | (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.