Provider Demographics
NPI:1740203181
Name:THITIPRASERTH, APINAN (MD)
Entity Type:Individual
Prefix:DR
First Name:APINAN
Middle Name:
Last Name:THITIPRASERTH
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 1:3331 W DEYOUNG STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5896
Mailing Address - Country:US
Mailing Address - Phone:618-997-9496
Mailing Address - Fax:618-997-8499
Practice Address - Street 1:3331 W DEYOUNG STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5896
Practice Address - Country:US
Practice Address - Phone:618-997-9496
Practice Address - Fax:618-997-8499
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036048878208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036048878Medicaid
0198560001Medicare NSC
IL036048878Medicaid
ILC38122Medicare UPIN