Provider Demographics
NPI:1629093000
Name:SAENGSAMRAN, SANIT (MD)
Entity Type:Individual
Prefix:
First Name:SANIT
Middle Name:
Last Name:SAENGSAMRAN
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 1:6340 CLAYTON RD APT 304
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-2513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6722
Practice Address - Country:US
Practice Address - Phone:618-463-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41230207P00000X
CODR-37522207P00000X
MO116980207P00000X
IL036-098626207P00000X
WAMD00036584207P00000X
UT327103-1205207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO106880AOtherBLUE SHIELD
IL6023191OtherBLUE SHIELD
IL036098626-1Medicaid
IL036098626-3Medicaid
IL1629093000-2Medicaid
MO1629093000Medicaid
MO207396409Medicaid
IL036098626-3Medicaid
IL1629093000-2Medicaid
MO106880AOtherBLUE SHIELD
MO1629093000Medicaid