Basic Information
| Provider Information | |||||||||
| NPI: | 1629093000 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SAENGSAMRAN | ||||||||
| FirstName: | SANIT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6340 CLAYTON RD APT 304 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631172513 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620026722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184637311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 01/23/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 41230 | MN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | DR-37522 | CO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 116980 | MO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 036-098626 | IL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD00036584 | WA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 327103-1205 | UT | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 106880A | 01 | MO | BLUE SHIELD | OTHER | 6023191 | 01 | IL | BLUE SHIELD | OTHER | 036098626-1 | 05 | IL | MEDICAID | 036098626-3 | 05 | IL | MEDICAID | 1629093000-2 | 05 | IL | MEDICAID | 1629093000 | 05 | MO | MEDICAID | 207396409 | 05 | MO | MEDICAID |