Provider Demographics
NPI:1942317086
Name:ANGSPATT PISIT MD SC
Entity Type:Organization
Organization Name:ANGSPATT PISIT MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PISIT
Authorized Official - Middle Name:
Authorized Official - Last Name:RANGSITHIENCHAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-687-7550
Mailing Address - Street 1:5601 VICTORIA DR.
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-2134
Mailing Address - Country:US
Mailing Address - Phone:708-687-7550
Mailing Address - Fax:
Practice Address - Street 1:5601 VICTORIA DR
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-2134
Practice Address - Country:US
Practice Address - Phone:708-687-7550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036044915Medicaid
IL036048818Medicaid
IL036059338Medicaid
IL036059338Medicaid
C428820Medicare UPIN
D89342Medicare UPIN
789400Medicare ID - Type UnspecifiedSHEELA JAYARAM, M.D.
IL036048818Medicaid
658820Medicare ID - Type UnspecifiedPISIT RANGSITHIENCHAI, MD