Provider Demographics
NPI:1982694980
Name:SAPYING, ATISAK (MD)
Entity Type:Individual
Prefix:DR
First Name:ATISAK
Middle Name:
Last Name:SAPYING
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 1:2170 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-6020
Mailing Address - Country:US
Mailing Address - Phone:815-547-5461
Mailing Address - Fax:
Practice Address - Street 1:2170 PEARL ST
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-6020
Practice Address - Country:US
Practice Address - Phone:815-547-5461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036079150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036079150OtherIL STATE LICENSE
IL036079150Medicaid
ILE34406Medicare UPIN
ILL33126Medicare ID - Type UnspecifiedMEDICARE