Provider Demographics
NPI:1700808763
Name:VAJARANANT, THASARAT S (MD)
Entity Type:Individual
Prefix:
First Name:THASARAT
Middle Name:S
Last Name:VAJARANANT
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 1:1855 W TAYLOR STREET
Mailing Address - Street 2:2.21 EEI, MC 648
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-996-7030
Mailing Address - Fax:312-996-7770
Practice Address - Street 1:1855 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7242
Practice Address - Country:US
Practice Address - Phone:312-996-7030
Practice Address - Fax:312-996-7770
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115587207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology