Provider Demographics
NPI:1114362456
Name:ASAP WELLNESS CENTER, SC
Entity Type:Organization
Organization Name:ASAP WELLNESS CENTER, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AKAVUT
Authorized Official - Middle Name:
Authorized Official - Last Name:SUESAKUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-532-7472
Mailing Address - Street 1:730 S DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1838
Mailing Address - Country:US
Mailing Address - Phone:312-588-1104
Mailing Address - Fax:
Practice Address - Street 1:730 S DEARBORN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1838
Practice Address - Country:US
Practice Address - Phone:312-588-1104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty