Provider Demographics
NPI:1215935663
Name:LERTRATANAKUL, YONGSUK - (MD)
Entity type:Individual
Prefix:DR
First Name:YONGSUK
Middle Name:-
Last Name:LERTRATANAKUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 N LAKE SHORE DR
Mailing Address - Street 2:UNIT 8D
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2818
Mailing Address - Country:US
Mailing Address - Phone:773-665-3333
Mailing Address - Fax:773-665-3312
Practice Address - Street 1:2900 N LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5640
Practice Address - Country:US
Practice Address - Phone:773-665-3333
Practice Address - Fax:773-665-3312
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
IL207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology