Provider Demographics
NPI:1205806197
Name:NAPAWAN, CHIRADEJ (MD)
Entity type:Individual
Prefix:MR
First Name:CHIRADEJ
Middle Name:
Last Name:NAPAWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHIRADEJ
Other - Middle Name:
Other - Last Name:NAPAWAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:101 S BURR BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:KEWANEE
Mailing Address - State:IL
Mailing Address - Zip Code:61443-2257
Mailing Address - Country:US
Mailing Address - Phone:309-852-0409
Mailing Address - Fax:309-852-3000
Practice Address - Street 1:855 ILLINI DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-2907
Practice Address - Country:US
Practice Address - Phone:309-792-7897
Practice Address - Fax:309-792-7898
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2014-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066736207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036066736Medicaid
IL036066736Medicaid
ILC03960Medicare UPIN
IL712410Medicare PIN