MEDICARE: DR. SRINARONG KITTISOPIKUL M.D., PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	036-077765	IL

General Provider Information

NPI Number	:	1558382549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SRINARONG KITTISOPIKUL M.D., PHD

Provider Business Mailing Address
First Line	:	1711 GIDDINGTON CT
Second Line	:
City	:	NEW LENOX
State	:	IL
Zip	:	60451-3029
Country	:	US
Telephone Number	:	708-217-4326
Fax Number	:

Provider Business Practice Location Address
First Line	:	1711 GIDDINGTON CT
Second Line	:
City	:	NEW LENOX
State	:	IL
Zip	:	60451-3029
Country	:	US
Telephone Number	:	708-217-4326
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	01/29/2024

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