Healthcare Provider Details

I. General information

NPI: 1942317086
Provider Name (Legal Business Name): ANGSPATT PISIT MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 VICTORIA DR
OAK FOREST IL
60452-2134
US

IV. Provider business mailing address

5601 VICTORIA DR.
OAK FOREST IL
60452-2134
US

V. Phone/Fax

Practice location:
  • Phone: 708-687-7550
  • Fax:
Mailing address:
  • Phone: 708-687-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. PISIT RANGSITHIENCHAI
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 708-687-7550