Niranat Dejtiranukul, M.D.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

036-050750 Issued in IL

Practice address

800 E Locust St
Olney, IL 62450-2553

Phone

(618) 395-7340

NPI assigned

Mar 12, 2007

Last updated

Oct 28, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Niranat Dejti Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Richland Memorial Hospital, Inc

  dba RMH Professional Services

  • Otolaryngology Physician
  • East Alton, IL
  • NPI 1104093590
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319760000000",
    "number": "1013049212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 97",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "624500097",
            "telephone_number": "618-395-7340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E LOCUST ST",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "624502553",
            "telephone_number": "618-395-7340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEJTIRANUKUL",
        "first_name": "NIRANAT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-12",
        "last_updated": "2011-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IL",
            "license": "036-050750",
            "primary": true
        },
        {
            "code": "207YX0602X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngic Allergy",
            "state": "IL",
            "license": "036-050750",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "08022315",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036050750",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "216183",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NIRANAT",
            "last_name": "DEJTI",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Pamela M Curtis, AUD
• Destiny R Dannells, NP-C
• Charlotte Davies
• Deaconess Specialty Physicians, Inc
• Deaconess Specialty Physicians, Inc
• Clark Edward Deshon, O.D., F.A.A.O
• Danielle Renee Deters, PHARMD
• Developmental Specialists of Southeastern Il, Inc.
• Luis C Devenecia Jr., MD
• Dorothea U Diciro, APN, CS

• Otolaryngology Physician in Olney, IL
• Providers in Olney, IL by specialty
• Otolaryngology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.