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General NPI Number Information
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NPI Number | 1356516231
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Entity Type | Organization
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Legal Business Name | YUKHOL LERTSBURAPA,M.D., S.C.
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 2222 W DIVISION ST 260
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City | CHICAGO
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State | IL
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Zip | 60622
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Country | US
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Telephone | 773-486-3535
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Fax |
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Provider Business Mailing Address
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Address Line | 2222 W DIVISION ST 260
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City | CHICAGO
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State | IL
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Zip | 60622
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Country | US
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Telephone | 773-486-3535
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN SURGEON
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Name | DR. YUKHOL LERTSBURAPA
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Credential | M.D., S.C.
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Telephone | 773-486-3535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 036045100
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License Number State | IL
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