DR. KRITTAPOOM AKRAWINTHAWONG (NPI# 1952680084) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952680084 |
| Entity Type | Individual |
| Full Name | DR. KRITTAPOOM AKRAWINTHAWONG |
| Credential | M.D. |
| Practice Address |
409 W Oak St Carbondale IL 62901-1464 |
| Mailing Address |
Po Box 3988 Carbondale IL 62902-3988 |
| Practice Telephone | 6185294455 |
| Practice Fax Number | 6183511287 |
| Mailing Telephone | 6185294455 |
| Enumeration Date | 2011-08-07 |
| Last Update Date | 2020-10-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 4301098268 | MI | Allopathic & Osteopathic Physicians |
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
036.147424 | IL | Allopathic & Osteopathic Physicians |
| Y | 207RC0001X |
Internal Medicine Specialization: Clinical Cardiac Electrophysiology |
036.147424 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | ILLINOIS PHYSICIAN LICENSE | 036.147424 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 217 S Park Ave Ste 2, Herrin, IL 629483611 | 6185294455 | 6183511287 |
| 301 S Park Ave, Herrin, IL 629483603 | 6185294455 | 6183511287 |
| 3905 W Ernestine Dr, Marion, IL 629595800 | 6185294455 | 6183511287 |
| Street Address |
409 W OAK ST |
| City | CARBONDALE |
| State | IL |
| Zip Code | 62901-1464 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366445975 | Agnes Blanche Delaney | Physician Assistant | 409 W Oak St, Carbondale, IL 62901-1464 | 2005-05-27 |
| 1003466269 | Lukas Ward | Physician Assistant | 409 W Oak St, Carbondale, IL 62901-1464 | 2019-09-18 |
| 1720632508 | Kaitlin Elizabeth Behnken | Internal Medicine | 409 W Oak St, Carbondale, IL 62901-1464 | 2019-07-30 |
| 1356995401 | Cassandra Chambers | Internal Medicine | 409 W Oak St, Carbondale, IL 62901-1464 | 2019-07-27 |
| 1992280598 | Corrie Lynn Farris | Physician Assistant | 409 W Oak St, Carbondale, IL 62901-1464 | 2018-09-28 |
| 1497255947 | Kimberly Hankins | Internal Medicine | 409 W Oak St, Carbondale, IL 62901-1464 | 2018-02-20 |
| 1689029993 | Ashley L. Brown | Internal Medicine | 409 W Oak St, Carbondale, IL 62901-1464 | 2016-04-25 |
| 1669833026 | Jessica Milburn | Nurse Practitioner | 409 W Oak St, Carbondale, IL 62901-1464 | 2016-03-14 |
| 1093193773 | Andrea Williams | Internal Medicine | 409 W Oak St, Carbondale, IL 62901-1414 | 2015-05-13 |
| 1730578535 | Desiree Castonguay | Physician Assistant | 409 W Oak St, 202, Carbondale, IL 62901-1414 | 2015-01-16 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558961268 | Gerad Aaron Harsy | Pharmacist | Walmart Pharmcy, 1450 East Main St, Carbondale, IL 62901 | 2020-10-30 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1306317383 | Rachael O Johnson | Nurse Practitioner | 404 S. Lewis Ln, Carbondale, IL 62901 | 2018-12-17 |
| 1740795194 | Megan Marie Zimmerman | Nurse Practitioner | 1100 W Diann Ln., Carbondale, IL 62901 | 2017-12-07 |
| 1295244242 | Amy Elizabeth Prudencio | Social Worker | 1301 E. Walnut Street, Carbondale, IL 62901 | 2017-09-21 |
| 1740708171 | Theresa Aleise Goodin | Speech-Language Pathologist | 1301 East Walnut Street, Carbondale, IL 62901 | 2017-09-06 |
| 1144762527 | Kathleen Chwalisz Rigney | Psychologist | 306 West Mill Street, Neurorestorative, Carbondale, IL 62901 | 2016-11-16 |
| 1285185173 | Shawnee Health Service and Development Corp | Social Worker | 404 S. Lewis Lane, Carbondale, IL 62901 | 2016-10-17 |
| 1437605094 | Arielle Greer | Nurse's Aide | 510 E. Russell St., A, Carbondale, IL 62901 | 2016-09-01 |
| 1518413863 | Complete Family Eyecare of Carbondale, PC | Optometrist | 1241 East Walnut Street, Carbondale, IL 62901 | 2016-08-28 |
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| Taxonomy Code | 207RC0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Clinical Cardiac Electrophysiology |
| A field of special interest within the subspecialty of cardiovascular disease, specialty of Internal Medicine, which involves intricate technical procedures to evaluate heart rhythms and determine appropriate treatment for them. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326446253 | Community Medical Center | Internal Medicine | 141 Salem Ave, Carbondale, PA 18407-2574 | 2014-12-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508363185 | Deaconess Specialty Physicians, Inc | Internal Medicine | 1340 Il Highway 1 Ste A, Carmi, IL 62821 | 2018-04-10 |
| 1568637833 | Krishnaswami Sriram | Internal Medicine | 611 Hunter Ln, Lake Forest, IL 60045-4905 | 2008-04-28 |
| 1083712467 | Ohio Valley Heartcare Inc | Internal Medicine | 1405 Locust St, Eldorado, IL 62930-1629 | 2006-09-20 |
| 1912917030 | Martin C Burke | Internal Medicine | 1006 S Michigan Ave, Suite 501, Chicago, IL 60605-2254 | 2006-08-09 |
| 1316998578 | West Suburban Cardiologists, Ltd. | Internal Medicine | 3118 N Ashland Ave, Chicago, IL 60657-3014 | 2006-05-13 |
| 1952359242 | Samer Dibs | Internal Medicine | 2222 W Division St Ste 340, Chicago, IL 60622-2995 | 2006-05-05 |
| 1164483145 | Mehran Jabbarzadeh | Internal Medicine | 900 Technology Way Ste 220, Libertyville, IL 60048-5364 | 2006-03-30 |
| 1497754634 | Rebecca Sue Riepshoff | Internal Medicine | Three Saint Elizabeth Blvd Ste 2800, O Fallon, IL 62269-1282 | 2005-07-19 |
| 1093712481 | Erica D Engelstein | Internal Medicine | 7447 W Talcott Ave Ste 222, Chicago, IL 60631-3713 | 2005-06-30 |
| 1861007239 | Marian Heart Rhythm Consultants Sc | Internal Medicine | 2222 W Division St Ste 205, Chicago, IL 60622-3094 | 2020-09-13 |
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| City | CARBONDALE |
| Zip Code | 62901 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.