Healthcare Provider Details

I. General information

NPI: 1649301961
Provider Name (Legal Business Name): SITTILERK TRIKALSARANSUKH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7114 W HOOD PL
KENNEWICK WA
99336-6712
US

IV. Provider business mailing address

7114 W HOOD PL
KENNEWICK WA
99336-6712
US

V. Phone/Fax

Practice location:
  • Phone: 509-734-4885
  • Fax:
Mailing address:
  • Phone: 509-734-4885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD00031517
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: