Healthcare Provider Details

I. General information

NPI: 1982718912
Provider Name (Legal Business Name): PISIT RANGSITHIENCHAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 05/05/2024
Certification Date: 05/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 VICTORIA DR
OAK FOREST IL
60452-2134
US

IV. Provider business mailing address

1809 CARDINAL CT
FLOSSMOOR IL
60422-2049
US

V. Phone/Fax

Practice location:
  • Phone: 708-687-7550
  • Fax: 708-687-7552
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number36-48818
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number36-48818
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: