Sirisak Suntharasantic, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036048367 Issued in IL

Practice address

4 Memorial Dr Ste 210
Alton, IL 62002-6751

Phone

(618) 463-0649

Fax

(618) 463-3390

NPI assigned

Dec 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Sirisak Sun Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525305600000",
    "number": "1114083888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 MEMORIAL DR STE 210",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026751",
            "telephone_number": "618-463-0649",
            "fax_number": "618-463-3390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 MEMORIAL DR STE 210",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026751",
            "telephone_number": "618-463-0649",
            "fax_number": "618-463-3390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUNTHARASANTIC",
        "first_name": "SIRISAK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-28",
        "last_updated": "2018-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036048367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036048367",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SIRISAK",
            "last_name": "SUN",
            "prefix": "DR.",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jeremie Studnicki, PHARMD
• Kerry Studnicki, RPH
• Yolanda A Suber, FNP-C
• Gabrielle Suhr
• Annissa M Sullivan, MA
• Nathaniel Blake Swaar, D.M.D.
• Kristen Katich Sweat, DC
• Jacquelyn Elaine Sweetman, PT
• Wonil Tae, MD
• Laquita Tague

• Pediatrics Physician in Alton, IL
• Providers in Alton, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2018; 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.