Provider Demographics
NPI:1740260736
Name:KUYAKANON, WEERAPAN (MD)
Entity type:Individual
Prefix:DR
First Name:WEERAPAN
Middle Name:
Last Name:KUYAKANON
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 1:855 ILLINI DR
Mailing Address - Street 2:
Mailing Address - City:SILVIS
Mailing Address - State:IL
Mailing Address - Zip Code:61282-2907
Mailing Address - Country:US
Mailing Address - Phone:309-792-4228
Mailing Address - Fax:309-281-2399
Practice Address - Street 1:855 ILLINI DR
Practice Address - Street 2:
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-2907
Practice Address - Country:US
Practice Address - Phone:309-792-4228
Practice Address - Fax:309-281-2399
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051026207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC44142Medicare UPIN