=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255460879
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRASOP RATTANANONT,M.D, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 NW 2ND ST
-----------------------------------------------------
City | ALEDO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61231-1404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-582-5388
-----------------------------------------------------
Fax | 309-582-5389
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 NW 2ND ST
-----------------------------------------------------
City | ALEDO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61231-1404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-582-5388
-----------------------------------------------------
Fax | 309-582-5389
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PRASOP RATTANANONT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 309-582-5388
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------