Dejtiranukul, Niranat

Dejtiranukul, Niranat is an individual health care provider with primary practice located at 800 E Locust St , Olney IL 62450-2553. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Otolaryngology, Allopathic & Osteopathic Physicians / Otolaryngic Allergy. Allopathic & Osteopathic Physicians / Otolaryngology is his primary health care specialty. Dejtiranukul, Niranat can be contacted via phone (618) 395-7340.

Contact Information

Primary practice address
800 E Locust St Olney IL 62450-2553
Phone: (618) 395-7340
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X 036-050750 Illinois
Allopathic & Osteopathic Physicians / Otolaryngic Allergy 207YX0602X 036-050750 Illinois

Profile Details

NPI number 1013049212
LBN Legal business name Dejtiranukul, Niranat
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 12th, 2007
Last updated Oct 28th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013049212 NPPES
Other 216183 MEDICARE PTAN
MEDICAID 036050750 MEDICARE PTAN
Other 08022315 MEDICARE PTAN

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