Provider Demographics
NPI:1356516231
Name:YUKHOL LERTSBURAPA,M.D., S.C.
Entity type:Organization
Organization Name:YUKHOL LERTSBURAPA,M.D., S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:YUKHOL
Authorized Official - Middle Name:
Authorized Official - Last Name:LERTSBURAPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, SC
Authorized Official - Phone:773-486-3535
Mailing Address - Street 1:2222 W DIVISION ST
Mailing Address - Street 2:260
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622
Mailing Address - Country:US
Mailing Address - Phone:773-486-3535
Mailing Address - Fax:
Practice Address - Street 1:2222 W DIVISION ST
Practice Address - Street 2:260
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622
Practice Address - Country:US
Practice Address - Phone:773-486-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036045100208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL314380Medicare PIN