Provider Demographics
NPI:1952468985
Name:KOMUTANON, RAPEEPAN S (MD)
Entity Type:Individual
Prefix:MRS
First Name:RAPEEPAN
Middle Name:S
Last Name:KOMUTANON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6543 W ALBERT AVENUE
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-1402
Mailing Address - Country:US
Mailing Address - Phone:847-966-1957
Mailing Address - Fax:773-588-6847
Practice Address - Street 1:3218 W LAWRENCE AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625
Practice Address - Country:US
Practice Address - Phone:773-588-6846
Practice Address - Fax:773-588-6847
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics