MEDICARE: DR. ATISAK SAPYING M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036079150	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036079150	OTHER	IL	IL STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982694980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ATISAK SAPYING M.D.

Provider Business Mailing Address
First Line	:	2170 PEARL ST
Second Line	:
City	:	BELVIDERE
State	:	IL
Zip	:	61008-6020
Country	:	US
Telephone Number	:	815-547-5461
Fax Number	:

Provider Business Practice Location Address
First Line	:	2170 PEARL ST
Second Line	:
City	:	BELVIDERE
State	:	IL
Zip	:	61008-6020
Country	:	US
Telephone Number	:	815-547-5461
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	10/01/2015

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