| NPI | 1891077160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | POONPUTT CHOTIPRASIDHI Owner/Physician 309-601-2814 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2024-11-04 |