Provider Demographics
NPI:1609075027
Name:BURANAKUL, YAI SUPAWIT (MD)
Entity Type:Individual
Prefix:DR
First Name:YAI
Middle Name:SUPAWIT
Last Name:BURANAKUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3618 N VERMILION ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-1129
Mailing Address - Country:US
Mailing Address - Phone:217-636-3349
Mailing Address - Fax:
Practice Address - Street 1:3618 N VERMILION ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-1129
Practice Address - Country:US
Practice Address - Phone:217-636-3349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109576208D00000X
IL036.109576208D00000X, 208000000X
IL036-109576207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics