Provider Demographics
NPI:1649301961
Name:TRIKALSARANSUKH, SITTILERK (MD)
Entity type:Individual
Prefix:
First Name:SITTILERK
Middle Name:
Last Name:TRIKALSARANSUKH
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 1:7114 W HOOD PL
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6712
Mailing Address - Country:US
Mailing Address - Phone:509-734-4885
Mailing Address - Fax:
Practice Address - Street 1:7114 W HOOD PL
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6712
Practice Address - Country:US
Practice Address - Phone:509-734-4885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031517207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3860TROtherASURIS NW
WA3860TROtherREGENCE BLUE SHIELD
WA51930OtherLABOR AND INDUSTRIES
WA1087543Medicaid
WA5980382OtherAETNA
WA814193OtherFIRST HLTH CCN COVENTRY
WA5166927OtherPPNI
WA9149389OtherPHCS MULTIPLAN
OR067897Medicaid
WA8927577OtherCRIME VICTIMS UNIT
WA8927577OtherCRIME VICTIMS UNIT
WAE87464Medicare UPIN