Provider Demographics
NPI:1891077160
Name:DIGESTIVE DISEASE SPECIALISTS
Entity type:Organization
Organization Name:DIGESTIVE DISEASE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:POONPUTT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOTIPRASIDHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-601-2814
Mailing Address - Street 1:525 VALLEY VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265
Mailing Address - Country:US
Mailing Address - Phone:309-601-2814
Mailing Address - Fax:309-601-2803
Practice Address - Street 1:525 VALLEY VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265
Practice Address - Country:US
Practice Address - Phone:309-601-2814
Practice Address - Fax:309-601-2803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363139231Medicare PIN