Provider Demographics
NPI:1528162252
Name:KULSAKDINUN, PAMORN (MD)
Entity type:Individual
Prefix:DR
First Name:PAMORN
Middle Name:
Last Name:KULSAKDINUN
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 1:1435 N RANDALL RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-2306
Mailing Address - Country:US
Mailing Address - Phone:847-741-5850
Mailing Address - Fax:847-931-5335
Practice Address - Street 1:1435 N RANDALL RD
Practice Address - Street 2:SUITE 302
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2306
Practice Address - Country:US
Practice Address - Phone:847-741-5850
Practice Address - Fax:847-931-5335
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098090207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098090Medicaid
IL036098090Medicaid
ILL78012Medicare PIN