Provider Demographics
NPI:1982718912
Name:RANGSITHIENCHAI, PISIT (MD)
Entity Type:Individual
Prefix:DR
First Name:PISIT
Middle Name:
Last Name:RANGSITHIENCHAI
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 1:1809 CARDINAL CT
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5601 VICTORIA DR
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-2134
Practice Address - Country:US
Practice Address - Phone:708-687-7550
Practice Address - Fax:708-687-7552
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2024-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-48818207K00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialist
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036048818Medicaid
658820Medicare ID - Type Unspecified
IL036048818Medicaid