MEDICARE: DR. THANCHANOK CHAIPRASIT M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207ZD0900X	Dermatopathology (Pathology) Physician	125078988	IL
3	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	125078988	IL

General Provider Information

NPI Number	:	1902471683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THANCHANOK CHAIPRASIT M.D.

Provider Business Mailing Address
First Line	:	2160 S 1ST AVE
Second Line	:
City	:	MAYWOOD
State	:	IL
Zip	:	60153-3328
Country	:	US
Telephone Number	:	708-216-3250
Fax Number	:

Provider Business Practice Location Address
First Line	:	2160 S. FIRST AVE
Second Line	:
City	:	MAYWOOD
State	:	IL
Zip	:	60153
Country	:	US
Telephone Number	:	708-327-2626
Fax Number	:

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

Provider Enumeration Date	:	05/25/2021
Last Update Date	:	01/20/2026

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