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General NPI Number Information
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NPI Number | 1750643748
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Entity Type | Organization
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Legal Business Name | SANGCHANTR MEDICAL ASSOCIATES, S.C.
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Dates
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Enumeration Date | 06/14/2012
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 2900 N LAKE SHORE DR GI LAB
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City | CHICAGO
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State | IL
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Zip | 60657-5640
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Country | US
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Telephone | 773-665-3084
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Fax | 773-665-3012
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Provider Business Mailing Address
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Address Line | 4207 RUTGERS LN
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City | NORTHBROOK
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State | IL
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Zip | 60062-2913
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Country | US
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Telephone | 773-348-7305
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Fax | 773-665-3012
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WANCHAI SANGCHANTR
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Credential | M.D.
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Telephone | 773-665-3084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 036-046323
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License Number State | IL
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