Healthcare Provider Details

I. General information

NPI: 1154326072
Provider Name (Legal Business Name): PRASOP RATTANANONT M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 NW 2ND ST
ALEDO IL
61231-1404
US

IV. Provider business mailing address

301 NW 2ND ST
ALEDO IL
61231-1404
US

V. Phone/Fax

Practice location:
  • Phone: 309-582-5388
  • Fax: 309-582-5389
Mailing address:
  • Phone: 309-582-5388
  • Fax: 309-582-5389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: